Acute Pain in the Emergency Department: The Challenges.

Acute pain is the reason that the majority of patients present to the emergency department.Failure to adequately treat acute pain in the emergency department has been labelled a public health problem.The College of Emergency Medicine has set standards for the timelines and adequacy in management of pain in both adults and children.Joint Care Quality Commission and College of Emergency Medicine national audit demonstrates the gap between standards and current practice.The new Department of Health clinical quality indicators for emergency medicine do not include a measure of pain.Untreated pain can have short and long term effects, including sensitisation to pain episodes in later life.A range of non-pharmacological and pharmacological interventions have been shown to be effective for procedural pain management in infants and children, and are most effective when used in combination.Developmental changes in pain responses, analgesic response and drug pharmacokinetics need to be taken into account when planning procedural pain management for neonates.Comprehensive evidence based guidelines are available to guide effective procedural pain management in neonates, infants and older children.