Akademik Veri Yönetim Sistemi
Turkiye Klinikleri, Ankara, 2025
Pain constitutes an integral aspect of the human condition, encompassing both physiological and psychological dimensions. It is a frequent cause of attendance at emergency departments (EDs). The effective management of pain has been demonstrated to have a number of benefits, including the alleviation of symptoms, the facilitation of diagnostic processes, the prevention of complications, and the enhancement of patient satisfaction. Delayed or inadequate analgesia has the potential to engender significant ethical and clinical dilemmas, particularly in vulnerable populations such as paediatric, geriatric, pregnant, oncology, and cognitively impaired patients. Consequently, a comprehensive, evidence-based, and patient-centred approach to the assessment, treatment, and follow-up of pain in the ED is of critical importance. The assessment of pain is dependent on the utilisation of validated tools, including the Numeric Rating Scale (NRS), the Visual Analog Scale (VAS), facial expression scales, and behavioural observation methods. The selection of instrument must be adapted to the patient group, with the employment of specialised scales for children, older adults, or individuals experiencing communication difficulties. It is imperative to acknowledge that pain assessment should be regarded as a dynamic process, necessitating regular re-evaluation of treatment responses and meticulous consideration of individual differences. Pharmacologic treatment follows a stepwise approach. Paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) are first-line options for mild to moderate pain, whereas opioids are titrated for severe cases. Given the risks of dependence and adverse effects, multimodal analgesia is recommended. For neuropathic pain, adjuvant agents such as gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors are valuable. Ketamine, as an NMDA antagonist, provides a safe and effective alternative in opioid-refractory cases. Non-pharmacological interventions complement pharmacological treatment and include cold or heat application, immobilization, transcutaneous electrical nerve stimulation (TENS), relaxation techniques, mindfulness, and cognitive-behavioral therapy. These methods are effective in both acute and chronic pain management and can reduce reliance on opioids. In selected cases, regional nerve blocks and interventional techniques offer rapid and effective analgesia, further improving patient outcomes. In conclusion, the success of pain management in emergency medicine depends on accurate assessment, appropriate treatment selection, multidisciplinary collaboration, and a patient-centered approach. Effective pain control should be regarded not only as a clinical necessity but also as an ethical responsibility. Integrating pharmacologic and non-pharmacologic methods with individualized strategies enhances patient trust, improves quality of care, and ensures more humane and comprehensive pain management in the emergency setting.