We have an ethical responsibility to remain committed to treating pain while simultaneously avoiding foolish use of opioids. To do this we need tools: [resources to come]
The words - How do we normalize pain, express empathy, educate on the risks and harms of opioids, and build that alliance and trust needed to break a dysfunctional pattern of harmful opioid use?
The knowledge - What is opioid induced hyperalgesia? How do you diagnosis a frozen shoulder versus an impingement syndrome? What is a migraine? How do you diagnose sacroiliac joint pain? What can be treated without medicines or injections of any kind? Hyperalgesia? addiction? tolerance? withdrawal? What insights can be taken from addiction medicine and pain medicine and applied to ED care?
The drugs - Treating acute pain without opioids requires expanding knowledge of the dosing, indications/contraindications, and side effects of several key drugs:
Ketamine: oral, iv, im and intranasal
Buprenorphine: iv/im, sublingual, buccal, transdermal
NSAIDs and Acetaminophen in all their forms
Lidocaine-intravenous, subcuataneous and topical
Neuroleptics: olanzepine, haldol,droperidol,chlorpromazine
The injections - Trigger points, joints, nerve blocks- how do you do them? When should do them? How often? What do you inject? How train up? Skill maintenance? Billing? Quality control?
The partners - What is the long-term plan? Is there handoff to a longitudinal provider? How do you integrate ED interventions into office-based primary care, surgical, and specialty pain care.