Page 35 Acute Pain Management

Acute pain following spinal cord injury
1. Gabapentinoids (gabapentin/pregabalin) (S), intravenous opioids, ketamine or lignocaine
(lidocaine) (U) tramadol, self‐hypnosis and electromyelograph biofeedback (N) are
effective in the treatment of neuropathic pain following spinal cord injury (Level II).

 Treatment of acute spinal cord pain is largely based on evidence from studies of other
neuropathic and nociceptive pain syndromes (U).

Acute burn injury pain
1. The use of biosynthetic dressings is associated with a decrease in time to healing and a
reduction in pain during burn dressings changes (N) (Level I [Cochrane Review]).

2. Opioids, particularly via PCA, are effective in burn pain, including procedural pain (S)
(Level II). SUMMARY
3. Augmented reality techniques (N) (Level II), virtual reality or distraction techniques (N)
(Level III‐3) reduce pain during burn dressings.
4. Gabapentin reduces pain and opioid consumption following acute burn injury (N)
(Level III‐3).

5. PCA with ketamine and midazolam mixture provides effective analgesia and sedation for
burn dressings (N) (Level IV).
 Acute pain following burn injury can be nociceptive and/or neuropathic in nature and
may be constant (background pain), intermittent or procedure‐related.
 Acute pain following burn injury requires aggressive multimodal and multidisciplinary
treatment.
Acute back pain
1. Acute low back pain is non‐specific in about 95% of cases and serious causes are rare;
common examination and investigation findings also occur in asymptomatic controls and
may not be the cause of pain (U) (Level I).

2. Advice to stay active, ‘activity‐focused’ printed and verbal information, and behavioural
therapy interventions are beneficial in acute low back pain (U) (Level I).
3. Advice to stay active, exercises, multimodal therapy and pulsed electromagnetic therapy
(in the short term) are effective in acute neck pain (U) (Level I).
4. Soft collars are not effective for acute neck pain (U) (Level I).
5. Appropriate investigations are indicated in cases of acute low back pain when alerting
features (‘red flags’) of serious conditions are present (U) (Level III‐2).

6. Psychosocial and occupational factors (‘yellow flags’) appear to be associated with
progression from acute to chronic back pain; such factors should be assessed early to
facilitate intervention (U) (Level III‐2).
Acute musculoskeletal pain
1. Topical and oral NSAIDs improve acute shoulder pain (U) (Level I).
2. Subacromial corticosteroid injection relieves acute shoulder pain in the early stages (U)
(Level I).
3. Exercises improve acute shoulder pain in patients with rotator cuff disease (U) (Level I).

Acute pain management: scientific evidence xxxv