Page 36 Acute Pain Management

4. Therapeutic ultrasound may improve acute shoulder pain in calcific tendonitis (U)
(Level I).
5. Advice to stay active, exercises, injection therapy and foot orthoses are effective in acute
patellofemoral pain (U) (Level I).

6. Low‐level laser therapy is ineffective in the management of patellofemoral pain (U)
(Level I).
 A management plan for acute musculoskeletal pain should comprise the elements of
assessment (history and physical examination, but ancillary investigations are not
SUMMARY  Information should be provided to patients in correct but neutral terms with the
generally indicated), management (information, assurance, advice to resume normal
activity, pain management) and review to reassess pain and revise management plan (U).

avoidance of alarming diagnostic labels to overcome inappropriate expectations, fears or
mistaken beliefs (U).
 Regular paracetamol, then if ineffective, NSAIDs, may be used for acute musculoskeletal
pain (U).
 Oral opioids, preferably short‐acting agents at regular intervals, may be necessary to
relieve severe acute musculoskeletal pain; ongoing need for such treatment requires
reassessment (U).
 Adjuvant agents such as anticonvulsants, antidepressants and muscle relaxants are not
recommended for the routine treatment of acute musculoskeletal pain (U).

Acute medical pain
Acute abdominal pain
1. Provision of analgesia does not interfere with the diagnostic process in acute abdominal
pain (S) (Level I [Cochrane Review]).

2. Non‐selective NSAIDs, opioids and intravenous metamizole (dipyrone) provide effective
analgesia for renal colic (N) (Level I [Cochrane Review]).
3. Non‐selective NSAIDs given for renal colic reduce requirements for rescue analgesia and
produce less vomiting compared with opioids, particularly pethidine (meperidine) (U)
(Level I [Cochrane Review]).

4. High frequency TENS is effective in primary dysmenorrhoea (N) (Level I [Cochrane
Review]).
5. The onset of analgesia is faster when non‐selective NSAIDs are given intravenously for
the treatment of renal colic (U) (Level I).
6. Antispasmodics and peppermint oil are effective for the treatment of acute pain in
irritable bowel syndrome (U) and gastrointestinal spasm (N) (Level I).
7. Non‐selective NSAIDs and vitamin B1 are effective in the treatment of primary
dysmenorrhoea (U) (Level I).
8. There is no difference between pethidine and morphine in the treatment of renal colic
(U) (Level II).
9. Parenteral non‐selective NSAIDs are as effective as parenteral opioids in the treatment of
biliary colic (U) (Level II).

xxxvi Acute Pain Management: Scientific Evidence