The pain in the Emergency Department: Choosing and treating wisely before and during the COVID-19 era
https://doi.org/10.4081/ecj.2021.9903
Accepted: 12 November 2021
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Pain is a frequent reason for referral to the Emergency Department (ED). Adequate management of pain is a moral and ethical imperative. If not correctly treated, acute pain can cause physical and psychological complications, and become chronic with severe consequences such as anxiety, depression, and social isolation. As consequence, emergency clinicians should treat pain as soon as possible, avoiding delays even in case of acute abdominal pain. Pain management is particularly complex in the elderly and emergency clinicians should always consider AGS Beers criteria ® to avoid inappropriate medications, severe side-effects, and drug-drug interactions. Pain is also a common cause of delirium in older patients. The SARS CoV-2 infection not only can cause acute pain, but also exacerbate chronic pain, particularly in the elderly, who are at high risk to be infected. Looking at all this evidence, emergency clinicians should treat pain with different strategies according to their experience and cultural background, making the right choice for each patient. This work is a critical review of the pain management in the ED, with a particular attention on the effects of COVID-19 in the EDs. We conducted a systematic search of the following databases: PubMed, Google Scholar, Science Direct, Medline from 2000 to 2020, using the keywords of “pain”, “emergency”, “COVID19”, “elderly”, “palliative care”, “ketamine”, “dexmedetomidine”, and “post-traumatic stress disorder”. The aim of this review is to help emergency clinicians to correctly manage pain in the ED with a new point of view regarding the pain management in COVID-19 patients.
Cordell WH, Keene KK, Giles BK, et al. The high prevalence of pain in emergency medical care. Am J Emerg Med 2002;20:165-9. DOI: https://doi.org/10.1053/ajem.2002.32643
Legge 22 dicembre 2017, n. 219. Norme in materia di consenso informato e di disposizioni anticipate di trattamento. (18G00006). GU Serie Generale n.12 del 16-01-2018. Available from: https://www.gazzettaufficiale.it/eli/id/2018/1/16/18G00006/sg
Stang AS, Hartling L, Fera C, et al. Quality indicators for the assessment and management of pain in the emergency department: a systematic review. Pain Res Manag 2014;19:e179-90. DOI: https://doi.org/10.1155/2014/269140
Rupp T, Delaney KA. Inadequate analgesia in emergency medicine. Ann Emerg Med 2004;43:494-503. DOI: https://doi.org/10.1016/j.annemergmed.2003.11.019
Janati M, Kariman H, Memary E, et al. Educational intervention effect on pain management quality in emergency department; a clinical audit. Adv J Emerg Med 2018;2:e16.
Schreiber JA, Cantrell D, Moe KA, , et al. Improving knowledge, assessment, and attitudes related to pain management: evaluation of an intervention. Pain Manag Nurs 2014;15:474-81. DOI: https://doi.org/10.1016/j.pmn.2012.12.006
Bayuo J, Munn Z, Campbell J. Assessment and management of burn pain at the Komfo Anokye Teaching Hospital: a best practice implementation project. JBI Database System Rev Implement Rep 2017;15:2398-418. DOI: https://doi.org/10.11124/JBISRIR-2016-003272
Sampson FC, Goodacre SW, O'Cathain A. Interventions to improve the management of pain in emergency departments: systematic review and narrative synthesis. Emerg Med J 2014;31:e9-e18. DOI: https://doi.org/10.1136/emermed-2013-203079
Kasasbeh MAM, McCabe C, Payne S. Action learning: an effective way to improve cancer-related pain management. J Clin Nurs 2017;26:3430-41. DOI: https://doi.org/10.1111/jocn.13709
Ridderikhof ML, Schyns FJ, Schep NW, et al. Emergency department pain management in adult patients with traumatic injuries before and after implementation of a nurse initiated pain treatment protocol utilizing fentanyl for severe pain. J Emerg Med 2017;52:417-25. DOI: https://doi.org/10.1016/j.jemermed.2016.07.015
Salvetti MdG, Pimenta CAdM, Braga PE, Corrêa CF. Disability related to chronic low back pain: prevalence and associated factors. Rev Esc Enferm USP 2012;46:16-23. DOI: https://doi.org/10.1590/S0080-62342012000700003
Askew RL, Cook KF, Revicki DA, et al. Evidence from diverse clinical populations supported clinical validity of PROMIS pain interference and pain behavior. J Clin Epidemiol 2016;73:103-11. DOI: https://doi.org/10.1016/j.jclinepi.2015.08.035
Goesling J, Clauw DJ, Hassett AL. Pain and depression: an integrative review of neurobiological and psychological factors. Curr Psychiatry Rep 2013;15:421. DOI: https://doi.org/10.1007/s11920-013-0421-0
Langley P, Muller-Schwefe G, Nicolau A, et al. The societal impact of pain in the European Union: health-related quality of life and healthcare resource utilization. J Med Econ 2010;13:571e81. DOI: https://doi.org/10.3111/13696998.2010.516709
Gaskin DJ, Richard P. The economic costs of pain in the United States. J Pain 2012;13:715-24. DOI: https://doi.org/10.1016/j.jpain.2012.03.009
Andersson V, Bergman S, Henoch I, et al. Pain and pain management in hospitalized patients before and after an intervention. Scand J Pain 2017;15:22-9. DOI: https://doi.org/10.1016/j.sjpain.2016.11.006
Merskey HE. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. Pain Suppl 1986;3:S1-226.
Del Giorno R, Frumento P, Varrassi G, et al. Assessment of chronic pain and access to pain therapy: a cross-sectional population-based study. J Pain Res 2017;10:2577e84. DOI: https://doi.org/10.2147/JPR.S136292
Fatoye F, Gebrye T, Odeyemi I. Real-world incidence and prevalence of low back pain using routinely collected data. Rheumatol Int 2019;39:619e26. DOI: https://doi.org/10.1007/s00296-019-04273-0
Latina R, De Marinis MG, Giordano F, et al. Epidemiology of chronic pain in the Latium Region, Italy: a cross-sectional study on the clinical characteristics of patients attending pain clinics. Pain Manag Nurs 2019;20:373e81. DOI: https://doi.org/10.1016/j.pmn.2019.01.005
Niv D, Devor M. Chronic pain as a disease in its own right. Pain Pract 2004;4:179–81. DOI: https://doi.org/10.1111/j.1533-2500.2004.04301.x
Hylands-White N, Duarte RV, Raphael JH. An overview of treatment approaches for chronic pain management. Rheumatol Int 2017;37:29e42. DOI: https://doi.org/10.1007/s00296-016-3481-8
Todd KH, Ducharme J, Choiniere M, et al. Pain in the emergency department: results of the pain and emergency medicine initiative (PEMI) multicenter study. J Pain 2007;8:460-6. DOI: https://doi.org/10.1016/j.jpain.2006.12.005
Gordon DB, Pellino TA, Miaskowski C, et al. A 10-year review of quality improvement monitoring in pain management: recommendations for standardized outcome measures. Pain Manag Nurs 2002;3:116-30. DOI: https://doi.org/10.1053/jpmn.2002.127570
Todd KH, Sloan EP, Chen C, et al. Survey of pain etiology, management practices and patient satisfaction in two urban emergency departments. CJEM 2002;4:252-6. DOI: https://doi.org/10.1017/S1481803500007478
Natesan S, Lee J, Volkamer H, Thoureen T. Evidence-Based Medicine Approach to Abdominal Pain. Emerg Med Clin North Am 2016;34:165-90. DOI: https://doi.org/10.1016/j.emc.2015.12.008
Ranji SR, Goldman LE, Simel DL, Shojania KG. Do opiates affect the clinical evaluation of patients with acute abdominal pain? JAMA 2006;296:1764-74. DOI: https://doi.org/10.1001/jama.296.14.1764
Attard AR, Corlett MJ, Kidner NJ, et al. Safety of early pain relief for acute abdominal pain. BMJ 1992;305:554–6. DOI: https://doi.org/10.1136/bmj.305.6853.554
Pace S, Burke TF. Intravenous morphine for early pain relief in patients with acute abdominal pain. Acad Emerg Med 1996;3:1086–92. DOI: https://doi.org/10.1111/j.1553-2712.1996.tb03365.x
LoVecchio F, Oster N, Sturmann K, et al. The use of analgesics in patients with acute abdominal pain. J Emerg Med 1997;15:775–9. DOI: https://doi.org/10.1016/S0736-4679(97)00183-2
Vermeulen B, Morabia A, Unger PF, et al. Acute appendicitis: Influence of early pain relief on the accuracy of clinical and US findings in the decision to operate – A randomized trial. Radiology 1999;210:639–43. DOI: https://doi.org/10.1148/radiology.210.3.r99fe54639
Mahadevan M, Graff L. Prospective randomized study of analgesic use for ED patients with right lower quadrant abdominal pain. Am J Emerg Med 2000;18:753–6. DOI: https://doi.org/10.1053/ajem.2000.16315
Thomas SH, Silen W, Cheema F, et al. Effects of morphine analgesia on diagnostic accuracy in Emergency Department patients with abdominal pain: A prospective, randomized trial. J Am Coll Surg 2003;196:18–31. DOI: https://doi.org/10.1016/S1072-7515(02)01480-1
Amoli HA, Golozar A, Keshavarzi S, et al. Morphine analgesia in patients with acute appendicitis: A randomised double-blind clinical trial. Emerg Med J 2008;25:586–9. DOI: https://doi.org/10.1136/emj.2007.050914
Gallagher EJ, Esses D, Lee C, et al. Randomized clinical trial of morphine in acute abdominal pain. Ann Emerg Med 2006;48:150–60. DOI: https://doi.org/10.1016/j.annemergmed.2005.11.020
Manterola C, Astudillo P, Losada H, et al. Analgesia in patients with acute abdominal pain. Cochrane Database Syst Rev 2007;3:CD005660. DOI: https://doi.org/10.1002/14651858.CD005660.pub2
Manterola C, Vial M, Moraga J, Astudillo P. Analgesia in patients with acute abdominal pain. Cochrane Database Syst Rev 2011;1:CD005660. DOI: https://doi.org/10.1002/14651858.CD005660.pub3
Falch C, Vicente D, Häberle H, et al. Treatment of acute abdominal pain in the emergency room: a systematic review of the literature. Eur J Pain 2014;18:902-13. DOI: https://doi.org/10.1002/j.1532-2149.2014.00456.x
Stigliano S, Sternby H, de Madaria E, et al. Early management of acute pancreatitis: A review of the best evidence. Dig Liver Dis 2017;49:585-94. DOI: https://doi.org/10.1016/j.dld.2017.01.168
Abdolrazaghnejad A, Banaie M, Tavakoli N, et al. Pain management in the emergency department: a review article on options and methods. Adv J Emerg Med 2018;2:e45.
Thompson DR. Narcotic analgesic effects on the sphincter of Oddi: a review of the data and therapeutic implications in treating pancreatitis. Am J Gastroenterol 2001;96:1266-72. DOI: https://doi.org/10.1111/j.1572-0241.2001.03536.x
Langford RM. Pain management today - what have we learned? Clin Rheumatol 2006;25:S2-8. DOI: https://doi.org/10.1007/s10067-006-0311-5
Ricciotti E, FitzGerald GA. Prostaglandins and Inflammation. Arterioscler Thromb Vasc Biol 2011;31:986–1000. DOI: https://doi.org/10.1161/ATVBAHA.110.207449
Süleyman H, Demircan B, Karagöz Y. Anti-inflammatory and side effects of cyclooxygenase inhibitors. Pharmacol Rep 2007;59:247-58.
Moore AR, Derry S, Straube S, et al. Faster, higher, stronger? Evidence for formulation and efficacy for ibuprofen in acute pain. Pain 2014;155:14-21. DOI: https://doi.org/10.1016/j.pain.2013.08.013
Barbagallo M, Sacerdote P. Ibuprofen in the treatment of children’s inflammatory pain: a clinical and pharmacological overview. Minerva Pediatr 2019;71:82-99. DOI: https://doi.org/10.23736/S0026-4946.18.05453-1
Agenzia Italiana del Framaco (AIFA). Nota Informativa Importante su ketorolac trometamina (13/04/2015). AIFA, 2015. Available from: https://www.aifa.gov.it/web/guest/-/nota-informativa-importante-su-ketorolac-trometamina-13-04-2015-
AIFA. Ketorolac. Available from: https://farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet?pdfFileName=footer_000898_037850_RCP.pdf&sys=m0b1l3
Hyllested M, Jones S, Pedersen JL, Kehlet H. Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: a qualitative review. Br J Anaesth 2002;88:199-214. DOI: https://doi.org/10.1093/bja/88.2.199
Wong I, St John-Green C, Walker SM. Opioid-sparing effects of perioperative paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) in children. Paediatr Anaesth 2013;23:475-95. DOI: https://doi.org/10.1111/pan.12163
Tan M, Law LS, Gan TJ. Optimizing pain management to facilitate Enhanced Recovery after Surgery pathways. Can J Anesth 2015;62:203–18. DOI: https://doi.org/10.1007/s12630-014-0275-x
Dunn LK, Durieux ME, Nemergut EC. Non-opioid analgesics: Novel approaches to perioperative analgesia for major spine surgery. Best Pract Res Clin Anaesthesiol 2016;30:79–89. DOI: https://doi.org/10.1016/j.bpa.2015.11.002
Gelman D, Gelmanas A, Urbanaitė D, et al. Role of multimodal analgesia in the evolving enhanced recovery after surgery pathways. Medicina (Kaunas) 2018;54:20. DOI: https://doi.org/10.3390/medicina54020020
Alford DP, Compton P, Samet JH. Acute pain management for patients receiving maintenance methadone or buprenorphine therapy. Ann Intern Med 2006;144:127-34. DOI: https://doi.org/10.7326/0003-4819-144-2-200601170-00010
Annequin D, Carbajal R, Chauvin P, et al. Fixed 50% nitrous oxide oxygen mixture for painful procedures: A French survey. Pediatrics 2000;105:E47. DOI: https://doi.org/10.1542/peds.105.4.e47
Reinoso-Barbero F, Pascual-Pascual SI, de Lucas R, et al. Equimolar nitrous oxide/oxygen versus placebo for procedural pain in children: a randomized trial. Pediatrics 2011;127:e1464-70. DOI: https://doi.org/10.1542/peds.2010-1142
Goldman R. Equimolar nitrous oxide/oxygen is suitable for pain control with minor pediatric procedures. J Pediatr 2011;159:874. DOI: https://doi.org/10.1016/j.jpeds.2011.09.007
Gall O, Annequin D, Benoit G, et al. Adverse events of premixed nitrous oxide and oxygen for procedural sedation in children. Lancet 2001;358:1514-5. DOI: https://doi.org/10.1016/S0140-6736(01)06575-8
Roberts DC, McKay MP, Shaffer A. Increasing rates of emergency department visits for elderly patients in the United States, 1993–2003. Ann Emerg Med 2008;51:769–774. DOI: https://doi.org/10.1016/j.annemergmed.2007.09.011
Aminzadeh F, Dalziel WB. Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Ann Emerg Med 2002;39:238–47. DOI: https://doi.org/10.1067/mem.2002.121523
Samara N, Chevalley T, Samaras D, Gold G. Older patients in the emergency department: a review. Ann Emerg Med 2010;56:261–9. DOI: https://doi.org/10.1016/j.annemergmed.2010.04.015
Charles CV, Eaton A. Highlights From the 2019 AGS Beers Criteria® Updates. Sr Care Pharm. 2020;35:68-74. DOI: https://doi.org/10.4140/TCP.n.2019.68
DeRhodes KH. The dangers of ignoring the beers criteria-the prescribing cascade. JAMA Intern Med 2019;179:863-864. DOI: https://doi.org/10.1001/jamainternmed.2019.1288
Barnett K, Mercer S, Norbury M, et al. The epidemiology of multimorbidity in a large cross-sectional dataset: implications for health care, research and medical education. Lancet 2012;380:37–43. DOI: https://doi.org/10.1016/S0140-6736(12)60240-2
Ellis G, Marshall T, Ritchie C. Comprehensive geriatric assessment in the emergency department. Clin Interv Aging 2014;9:2033-43. DOI: https://doi.org/10.2147/CIA.S29662
van Oppen JD, Keillor L, Mitchell Á, et al. What older people want from emergency care: a systematic review. Emerg Med J 2019;36:754-61. DOI: https://doi.org/10.1136/emermed-2019-208589
By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 2019;67:674-94. DOI: https://doi.org/10.1111/jgs.15767
Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet 2014;383:911–22. DOI: https://doi.org/10.1016/S0140-6736(13)60688-1
Pisani MA, Murphy TE, Van Ness PH. Characteristics associated with delirium in older patients in a medical intensive care unit. Arch Intern Med 2007;167:1629–34. DOI: https://doi.org/10.1001/archinte.167.15.1629
Goldberg SE, Gladman JR, Bradshaw LE, et al. The diagnosis, prevalence and outcome of delirium in a cohort of older people with mental health problems on general hospital wards. Int J Geriatr Psychiatry 2014;29:32–40. DOI: https://doi.org/10.1002/gps.3961
European Delirium Association; American Delirium Society. The DSM-5 criteria, level of arousal and delirium diagnosis: Inclusiveness is safer. BMC Med 2014;12:141. DOI: https://doi.org/10.1186/s12916-014-0141-2
Young J, Inouye SK. Delirium in older people. BMJ 2007;334:842–6. DOI: https://doi.org/10.1136/bmj.39169.706574.AD
Agnoletti V, Ansaloni L, Catena F, et al. Postoperative Delirium after elective and emergency surgery: analysis and checking of risk factors. A study protocol. BMC Surg 2005;5:12. DOI: https://doi.org/10.1186/1471-2482-5-12
Clegg A, Young JB. Which medications to avoid in people at risk of delirium: A systematic review. Age Ageing 2011;40:23–9. DOI: https://doi.org/10.1093/ageing/afq140
Lauretani F, Bellelli G, Pelà G, et al. Treatment of delirium in older persons: what we should not do! Int J Mol Sci 2020;21:2397. DOI: https://doi.org/10.3390/ijms21072397
Devlin JW, Skrobik Y, Gélinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med 2018;46:e825-73.
Feast AR, White N, Lord K, et al. Pain and delirium in people with dementia in the acute general hospital setting. Age Ageing 2018;47:841-6. DOI: https://doi.org/10.1093/ageing/afy112
Schreier AM. Nursing care, delirium, and pain management for the hospitalized older adult. Pain Manag Nurs 2010;11:177–85. DOI: https://doi.org/10.1016/j.pmn.2009.07.002
Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc 2003;4:9-15. DOI: https://doi.org/10.1097/01.JAM.0000043422.31640.F7
Goldberg R. Calculated Decisions: Pain assessment in advanced dementia (PAINAD) scale. Emerg Med Pract 2019;21:CD1-CD2.
Fry M, Elliott R. Pragmatic evaluation of an observational pain assessment scale in the emergency department: The Pain Assessment in Advanced Dementia (PAINAD) scale. Australas Emerg Care 2018;21:131-6. DOI: https://doi.org/10.1016/j.auec.2018.09.001
Fry M, Arendts G, Chenoweth L. Emergency nurses' evaluation of observational pain assessment tools for older people with cognitive impairment. J Clin Nurs 2017;26:1281-90. DOI: https://doi.org/10.1111/jocn.13591
Royal College of Psychiatrists. National Audit of Dementia Care in General Hospitals 2016–2017: Third round of audit report. London: Royal College of Psychiatrists, 2017.
Singer T, Seymour B, O'Doherty J, et al. Empathy for pain involves the affective but not sensory components of pain. Science 2004;303:1157-62. DOI: https://doi.org/10.1126/science.1093535
Jackson PL, Brunet E, Meltzoff AN, Decety J. Empathy examined through the neural mechanisms involved in imagining how I feel versus how you feel pain. Neuropsychologia 2006;44:752–61. DOI: https://doi.org/10.1016/j.neuropsychologia.2005.07.015
Lamm C, Decety J, Singer T. Meta-analytic evidence for common and distinct neural networks associated with directly experienced pain and empathy for pain. NeuroImage 2011;54:2492–502. DOI: https://doi.org/10.1016/j.neuroimage.2010.10.014
Peled-Avron L, Goldstein P, Yellinek S, et al. Empathy during consoling touch is modulated by mu-rhythm: An EEG study. Neuropsychologia 2018;116:68-74. DOI: https://doi.org/10.1016/j.neuropsychologia.2017.04.026
Block AR. Investigation of the response of the spouse to chronic pain behavior. Psychosom Med 1981;43:415–22. DOI: https://doi.org/10.1097/00006842-198110000-00004
Lamm C, Porges EC, Cacioppo JT, Decety, J. Perspective taking is associated with specific facial responses during empathy for pain. Brain Res 2008;1227:153–61. DOI: https://doi.org/10.1016/j.brainres.2008.06.066
Goldstein P, Weissman-Fogel I, Shamay-Tsoory SG. The role of touch in regulating inter-partner physiological coupling during empathy for pain. Sci Rep 2017;7:3252. DOI: https://doi.org/10.1038/s41598-017-03627-7
Goldstein P, Shamay-Tsoory SG, Yellinek S, Weissman-Fogel I. Empathy predicts an experimental pain reduction during touch. J Pain 2016;17:1049-57. DOI: https://doi.org/10.1016/j.jpain.2016.06.007
Holt-Lunstad J, Birmingham W, Light KC. The influence of depressive symptomatology and perceived stress on plasma and salivary oxytocin before, during and after a support enhancement intervention. Psychoneuroendocrinology 2011;36:1249–56. DOI: https://doi.org/10.1016/j.psyneuen.2011.03.007
Dijkstra BM, Gamel C, van der Bijl JJ, et al. The effects of music on physiological responses and sedation scores in sedated, mechanically ventilated patients. J Clin Nurs 2010;19:1030–9. DOI: https://doi.org/10.1111/j.1365-2702.2009.02968.x
Chlan LL, Weinert CR, Heiderscheit A, et al. Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support: a randomized clinical trial. JAMA 2013;309:2335–44. DOI: https://doi.org/10.1001/jama.2013.5670
Han L, Li JP, Sit JW, et al. Effects of music intervention on physiological stress response and anxiety level of mechanically ventilated patients in China: a randomised controlled trial. J Clin Nurs 2010;19:978–87. DOI: https://doi.org/10.1111/j.1365-2702.2009.02845.x
Jaber S, Bahloul H, Guetin S, et al. Effects of music therapy in intensive care unit without sedation in weaning patients versus non-ventilated patients. Ann Fr Anesth Reanim 2007;26:30–8. DOI: https://doi.org/10.1016/j.annfar.2006.09.002
Hole J, Hirsch M, Ball E, Meads C. Music as an aid for postoperative recovery in adults: a systematic review and meta-analysis. Lancet 2015;386:1659-71. DOI: https://doi.org/10.1016/S0140-6736(15)60169-6
Bradt J, Dileo C. Music interventions for mechanically ventilated patients. In: The Cochrane Collaboration, editor. Cochrane Database Syst Rev 2014;2014:CD006902. DOI: https://doi.org/10.1002/14651858.CD006902.pub3
Messika J, Hajage D, Panneckoucke N, et al. Effect of a musical intervention on tolerance and efficacy of non-invasive ventilation in the ICU: study protocol for a randomized controlled trial (MUSique pour l'Insuffisance Respiratoire Aigue - Mus-IRA). Trials. 2016;17:450. DOI: https://doi.org/10.1186/s13063-016-1574-z
Gisondi MA. A case for education in palliative and end-of-life care in emergency medicine. Acad Emerg Med 2009;16:181-3. DOI: https://doi.org/10.1111/j.1553-2712.2008.00329.x
Ferrell BR. Family caregiving and cancer pain management. Anesth Analg 2019;129:1408-13. DOI: https://doi.org/10.1213/ANE.0000000000003937
Chi NC, Demiris G. Family caregivers' pain management in end-of-life care: a systematic review. Am J Hosp Palliat Care 2017;34:470-85. DOI: https://doi.org/10.1177/1049909116637359
Smith AK, Fisher J, Schonberg MA, et al. Am I doing the right thing? Provider perspectives on improving palliative care in the emergency department. Ann Emerg Med 2009;54:86-93. DOI: https://doi.org/10.1016/j.annemergmed.2008.08.022
Teno JM, Shu JE, Casarett D, et al. Timing of referral to hospice and quality of care: length of stay and bereaved family members’ perceptions of the timing of hospice referral. J Pain Symptom Manage 2007;34:120-5. DOI: https://doi.org/10.1016/j.jpainsymman.2007.04.014
Quill TE. Is length of stay on hospice a critical quality of care indicator? J Palliat Med 2007;10:290-2. DOI: https://doi.org/10.1089/jpm.2006.9984
Lamba S, Quest TE. Hospice care and the emergency department: rules, regulations, and referrals. Ann Emerg Med 2011;57:282-90. DOI: https://doi.org/10.1016/j.annemergmed.2010.06.569
Remuzzi A, Remuzzi G. COVID-19 and Italy: what next? Lancet 2020;395:1225-8. DOI: https://doi.org/10.1016/S0140-6736(20)30627-9
Poggiali E, Vercelli A, Mazzoni S, et al. COVID-19 pandemic, Piacenza calling. The survival strategy of an Italian emergency department. Acta Biomed 2020;91:1-3.
Maniscalco P, Poggiali E, Quattrini F, et al. The deep impact of novel covid-19 infection in an Orthopedics and traumatology department: The experience of the Piacenza hospital. Acta Biomed 2020;91:97-105.
Comelli I, Scioscioli F, Cervellin G. Impact of the covid-19 epidemic on census, organization and activity of a large urban emergency department. Acta Biomed 2020;91:45-9.
Turcato G, Zaboli A, Pfeifer N. The COVID-19 epidemic and reorganisation of triage, an observational study. Intern Emerg Med 2020;15:1517-24. DOI: https://doi.org/10.1007/s11739-020-02465-2
Carenzo L, Costantini E, Greco M, et al. Hospital surge capacity in a tertiary emergency referral centre during the COVID-19 outbreak in Italy. Anaesthesia 2020;75:928-34. DOI: https://doi.org/10.1111/anae.15072
World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report – 72. Available from: https://covid19.who.int/ (last access 16th November 2021)
Drozdzal S, Rosik J, Lechowicz K, et al. COVID-19: pain management in patients with SARS-CoV-2 infectionmolecular mechanisms, challenges, and perspectives. Brain Sci 2020;10:465. DOI: https://doi.org/10.3390/brainsci10070465
Widyadharma IPE, Sari NNSP, Pradnyaswari KE, et al. Pain as clinical manifestations of COVID-19 infection and its management in the pandemic era: a literature review. Egypt J Neurol Psychiatr Neurosurg 2020;56:121. DOI: https://doi.org/10.1186/s41983-020-00258-0
Alonso-Matielo H, da Silva Oliveira VR, de Oliveira VT, Dale CS. Pain in Covid Era. Front Physiol 2021;12:624154. DOI: https://doi.org/10.3389/fphys.2021.624154
Guo R, Chen L, Xing C, Liu T. Pain regulation by gut microbiota: molecular mechanism and therapeutic potential. Br J Anaesth 2019;123:637–54. DOI: https://doi.org/10.1016/j.bja.2019.07.026
Zhai L, Wang W, Wu L, Tang Z. Clinical Intelligence COVID-19 with abdominal symptoms and acute abdominal pain: a guide to identification for generalpractice. Br J Gen Pract 2020;70:358–9. DOI: https://doi.org/10.3399/bjgp20X710693
Oba J, Carvalho WB, de Silva CA, Delgado AF. Gastrointestinal manifestations and nutritional therapy during COVID-19 pandemic: a practical guide for pediatricians. Einstein (Sao Paulo) 2020;18:eRW5774. DOI: https://doi.org/10.31744/einstein_journal/2020RW5774
Poggiali E, Ramos PM, Bastoni D, et al. Abdominal pain: a real challenge in novel COVID-19 infection. Eur J Case Rep Intern Med 2020;7:001632.
Lechien JR, Chiesa-Estomba CM, Place S, et al. Clinical and epidemiological characteristics of 1420 European patients with mild-to-moderate coronavirus disease 2019. J Intern Med 2020;288:335–44. DOI: https://doi.org/10.1111/joim.13089
Trigo J, García-Azorín D, Planchuelo-Gómez Á, et al. Factors associated with the presence of headache in hospitalized COVID-19 patients and impact on prognosis: a retrospective cohort study. J Headache Pain 2020;21:1–10. DOI: https://doi.org/10.1186/s10194-020-01165-8
Su S, Cui H, Wang T, et al. Pain: a potential new label of COVID-19. Brain Behav Immun 2020;87:159–60. DOI: https://doi.org/10.1016/j.bbi.2020.05.025
Kanberg N, Ashton NJ, Anderson LM, et al. Neurochemical evidence of astrocytic and neuronal injury commonly found in COVID-19. Neurology 2020;95:e1754–9. DOI: https://doi.org/10.1212/WNL.0000000000010111
Lei L, Huang X, Zhang S, et al. Comparison of prevalence and associated factors of anxiety and depression among peopleaffected by versus people unaffected by quarantine during the COVID-19 Epidemic in Southwestern China. Med Sci Monit 2020;26:1–12. DOI: https://doi.org/10.12659/MSM.924609
Majumdar P, Biswas A, Sahu S. COVID-19 pandemic and lockdown: cause of sleep disruption, depression, somatic pain, and increased screen exposure of office workers and students of India. Chronobiol Int 2020;37:1191–1200. DOI: https://doi.org/10.1080/07420528.2020.1786107
American Society of Regional Anesthesiology. Recommendations on chronic pain practice during the COVID-19 pandemic. ASRA; 2020. Available from: https://www.asra.com/page/2903/recommendations-on-chronic-pain-practice-during-the-covid-19-pandemic
Shanthanna H, Strand NH, Provenzano DA, et al. Caring for patients with pain during the COVID-19 pandemic: consensus recommendations from an international expert panel. Anaesthesia 2020;75:935-44. DOI: https://doi.org/10.1111/anae.15076
Darnall BD, Carr DB, Schatman ME. Pain psychology and the biopsychosocial model of pain treatment: ethical imperatives and social responsibility. Pain Medicine 2017;18:1413–5. DOI: https://doi.org/10.1093/pm/pnw166
Lautenbacher S, Kundermann B, Krieg JC. Sleep deprivation and pain perception. Sleep Med Rev 2006;10:357–369. 24. DOI: https://doi.org/10.1016/j.smrv.2005.08.001
Barry DT, Pilver C, Potenza MN, Desai RA. Prevalence and psychiatric correlates of pain interference among men and women in the general population. J Psychiatr Res 2012;46:118–27. DOI: https://doi.org/10.1016/j.jpsychires.2011.09.004
Tang NK, Crane C. Suicidality in chronic pain: a review of the prevalence, risk factors and psychological links. Psychol Med 2006;36:575–86. DOI: https://doi.org/10.1017/S0033291705006859
Ren K, Dubner R. Interactions between the immune and nervous systems in pain. Nature Medicine 2010;16:1267–76. DOI: https://doi.org/10.1038/nm.2234
Marchand F, Perretti M, McMahon SB. Role of the immune system in chronic pain. Nature Rev Neurosci 2005;6:521–32. DOI: https://doi.org/10.1038/nrn1700
Chen G, Wu D, Guo W, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest 2020;130:2620–9. DOI: https://doi.org/10.1172/JCI137244
Pergolizzi JV Jr, Varrassi G, Magnusson P, et al. COVID-19 and NSAIDS: A narrative review of knowns and unknowns. Pain Ther 2020;9:353-8. DOI: https://doi.org/10.1007/s40122-020-00173-5
Russell B, Moss C, Rigg A, Van Hemelrijck M. COVID-19 and treatment with NSAIDs and corticosteroids: should we be limiting their use in the clinical setting? Ecancermedicalscience 2020;14:1023. DOI: https://doi.org/10.3332/ecancer.2020.1023
Day M. Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists. Br Med J 2020;368:m1086. DOI: https://doi.org/10.1136/bmj.m1086
British Medical Journal Best Practice. Coronavirus disease 2019 (COVID-19). Available from: https://bestpractice.bmj.com/info/coronavirus_covid-19/
Food and Drug Administration. FDA advises patients on use of non-steroidal anti-inflammatory drugs (NSAIDs) for COVID-19. FDA; 2020. Available from: https://www.fda.gov/drugs/drug-safety-and-availability/fda-advises-patients-use-non-steroidal-anti-inflammatory-drugs-nsaids-covid-19
EMA gives advice on the use of non-steroidal anti-inflammatories for COVID-19, 2020. Available from: https://www.ema.europa.eu/en/news/ema-gives-advice-use-non-steroidal-anti-inflammatories-covid-19
Drożdżal S, Rosik J, Lechowicz K, et al. COVID-19: Pain Management in Patients with SARS-CoV-2 Infection-Molecular Mechanisms, Challenges, and Perspectives. Brain Sci 2020;10:465. DOI: https://doi.org/10.3390/brainsci10070465
Caputo ND, Strayer RJ, Levitan R. Early self-proning in awake, non-intubated patients in the emergency department: a single ED’s experience during the COVID-19 pandemic. Acad Emerg Med 2020;27:375–8. DOI: https://doi.org/10.1111/acem.13994
Coppo A, Bellani G, Winterton D, et al. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study. Lancet Respir Med 2020;8:765-74. DOI: https://doi.org/10.1016/S2213-2600(20)30268-X
Bastoni D, Poggiali E, Vercelli A, et al. Prone positioning in patients treated with non-invasive ventilation for COVID-19 pneumonia in an Italian emergency department. Emerg Med J 2020;37:565-6. DOI: https://doi.org/10.1136/emermed-2020-209744
Ortoleva J. Consider adjunctive ketamine in mechanically ventilated Coronavirus Disease-2019 patients. J Cardiothorac Vasc Anesth 2020;34:2580. DOI: https://doi.org/10.1053/j.jvca.2020.04.037
Weinbroum AA. Perspectives of ketamine use in COVID-19 Patients. J Korean Med Sci 2021;36:e28. DOI: https://doi.org/10.3346/jkms.2021.36.e28
Vabretabret N, Britton GJ, Gruber C, et al. Immunology of COVID-19: current state of the science. Immunity. 2020;52(6):910-41. DOI: https://doi.org/10.1016/j.immuni.2020.05.002
Akinosoglou K, Gogos A, Papageorgiou C, et al. Ketamine in COVID-19 patients: Thinking out of the box. J Med Virol 2020:10.1002/jmv.26681 DOI: https://doi.org/10.1002/jmv.26681
Stockton J, Kyle-Sidell C. Dexmedetomidine and worsening hypoxemia in the setting of COVID-19: A case report. Am J Emerg Med 2020;38:2247.e1-2247.e2. DOI: https://doi.org/10.1016/j.ajem.2020.05.066
Hasanin A, Taha K, Abdelhamid B, et al. Evaluation of the effects of dexmedetomidine infusion on oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease. BMC Anesthesiol 2018;18:104. DOI: https://doi.org/10.1186/s12871-018-0572-y
Czepiel KS, Lucas AT, Whalen MJ, Mojica JE. Dexmedetomidine-associated hyperpyrexia in three critically ill patients with coronavirus disease 2019. Crit Care Explor 2020;2:e0213. DOI: https://doi.org/10.1097/CCE.0000000000000213
Buonanno P, Vargas M, Marra A, et al. End of life in the time of COVID-19 pandemic: take care of death. Acta Biomed 2020;91:e2020153.
Doldi M, Moscatelli A, Ravelli A, et al. Medicine and humanism in the time of COVID-19. Ethical choices. Acta Biomed 2020;91:e2020167.
The Lancet. Palliative care and the COVID-19 pandemic. Lancet. 2020;395:1168. DOI: https://doi.org/10.1016/S0140-6736(20)30822-9
Powell VD, Silveira MJ. What should palliative care's response be to the COVID-19 pandemic? J Pain Symptom Manage 2020;60:e1-e3. DOI: https://doi.org/10.1016/j.jpainsymman.2020.03.013
Borasio GD, Gamondi C, Obrist M, Jox R, For The Covid-Task Force Of Palliative Ch. COVID-19: decision making and palliative care. Swiss Med Wkly 2020;150:w20233. DOI: https://doi.org/10.4414/smw.2020.20233
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Downloads
Citations
