Journal of Urgent Care Medicine

Evidence Favors NSAIDs For Pediatric Acute Pain

A meta-analysis of 41 randomized clinical trials found that nonsteroidal anti-inflammatory drugs (NSAIDs) were as effective as ketamine and high-potency opioids for treating pediatric acute pain, while having fewer risks (N=4,935; median age 9.7 years). Researchers found all 3 drug categories outperformed placebo in treating that pain with at least moderate certainty. In the study, presented in JAMA Pediatrics, the reduction in pain severity was “modest” overall. Only NSAIDs reduced the need for rescue medication …

New Non-opioid Analgesic Suzetrigine Set to Launch for Treatment of Acute Pain

The Food and Drug Administration (FDA) last week approved the new non-opioid analgesic suzetrigine (Journavx) to treat moderate to severe acute pain in adults. Suzetrigine is an oral tablet that reduces pain by targeting the NaV1.8 pain-signaling pathway in the peripheral nervous system before the pain signals reach the brain. It is the first drug to be approved in this new class of pain management medicines, according to the FDA. Two randomized, double-blind trials of …

Bill Would Restrict Opioid Prescriptions for Acute Pain to 3 Days Nationally

Efforts to reduce access to opioid medications for acute pain have varied greatly from state to state, in spite of President Trump’s declaration that related addiction and deaths constitute a public health emergency. Now, a bipartisan bill just introduced in Congress would impose a national policy if it passes, restricting prescriptions for opioids for acute pain to 3 days (ample for the urgent care setting). Significantly, the bill would also authorize adding $1 billion to …

New Limits on Prescribing Opioids for Acute Pain

Ohio is placing new limits on the prescribing of opioid medications for acute pain, forbidding clinicians from writing more than a 7-day supply for adults, or a 5-day supply for minors (down from up to 90 days, currently). Prescribers will be allowed to override the acute pain limit if they identify a specific reason in their patients’ medical records, though this is not likely to apply in the urgent care setting. Further, the limits do …

December 2012

Evaluation and Management of Pain (Part 1): Acute Pain

Urgent message: Urgent care providers have a clinical, legal, and moral obligation to provide appropriate treatment for patients with pain. The first article in a two-part series addresses strategies for managing acute pain. TRACEY Q. DAVIDOFF, MD The interpretation of pain by patients is very subjective and not easily measured. That makes management of pain in the urgent care setting difficult. Current pain scales are often inaccurate or not truly reflective of a patient’s real …

Clinical Challenge: June, 2011

The patient is an otherwise healthy child, age 11, who presents with acute pain to the wrist following a blow. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Clinical Challenge: May, 2011

The patient is an otherwise healthy child, 3.5 years of age, who presents with acute pain in his right lower arm to the elbow. Examination reveals multiple fractures. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Clinical Challenge: October, 2009

A 57-Year-Old Woman with Acute Pain After a Fall The aptient is a 57-year-old woman who presented to urgent care complaining of severe pain in her right foot, leg, hip, and elbow. She reported that she fell three to four hours prior to presentation while outside walking her dog; she was “tripped up” in the pet’s leash. She presented ambulatory, but was unable to bear any weight on her right leg. Past medical history …

Acute Pain Management in Urgent Care Medicine

Urgent message: Urgent care practitioners are called upon daily to alleviate pain. A thorough understanding of the various pain syndromes and the pharmacology and analgesic potencies of various medications will aid in their safe and appropriate use. Marc R. Salzberg, MD, FACEP and Paolo T. Coppola, MD, FACEP Pain, either chronic or acute, is the main reason patients seek medical care. In this article, we will discuss acute pain management in an urgent care setting, …