Lipp et al. Critical Care 2013, 17: 212
"Emergency physicians care for patients with pain on an extremely frequent basis. The prevalence of pain as the presenting complaint of patients seeking emergency department (ED) care ranges from 38% to as high as 78%. As a result, evidence-based use of analgesics should be a foundational skill of emergency physicians. However, the literature consistently reports that emergency physicians are often poor at treating pain. Notwithstanding the prevalence of pain in the ED, many patients often report that their pain was not properly treated. In addition to a compromised patient experience, sub-optimal treatment of pain will result in decreased department flow, increased wait times, more return visits to the ED, and increased hospitalization rates.
Very few evidence-based resources and guidelines exist to inform emergency physicians on how to treat pain. One recent guideline on acute pain management compiled by the college of Anaesthetists of Australia and New Zealand was focused primarily on treating pain perioperatively and did not include stratified or graded recommendations based on the literature, highlighting the paucity of emergency medicine-specific guidance. Emergency physicians need an effective, evidenced-based approach to analyze and apply the options available for acute pain management.
The objective of this article is to synthesize and evaluate the quality of medical literature surrounding analgesia delivery in the adult ED using the Grading Assessment, Development and Evaluation (GRADE) framework. We further strived to provide emergency physicians with graded recommendations upon which analgesics should be used to treat adults with acute pain in the ED."
http://ccforum.com/content/pdf/cc12521.pdf