Patient controlled analgesia in the emergency department

Reduces pain and increases autonomy Acute severe pain that follows injury or onset of illness alerts patients to the likelihood of tissue damage (nociception) and drives much emergency department attendance.1 The prompt assessment and alleviation of pain is a quality benchmark for emergency departments internationally, and titrated intravenous opiates are the initial analgesic of choice for severe pain.2 3 Recent improvements in initial pain assessment and analgesic provision have occurred in UK emergency departments, but processes for referral to an inpatient team and time based standards for ward admission can interfere with effective pain management after the first dose of intravenous opiate. Recent surveys of patients and studies of care pathways suggest that current care is suboptimal in this regard.4 Two open label, multicentre, randomised trials of pain solutions in the emergency setting (PASTIES) by Smith and colleagues (doi:10.1136/bmj.h2988; doi:10.1136/bmj.h3147) provide new evidence to help us tackle this deficiency.5 6 The studies each enrolled a group of patients who commonly require parenteral analgesia throughout the first day of an emergency admission—adults with acute non-traumatic abdominal pain and adults with acute traumatic injury. …