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Sat Jan 29 07:06:52 GMT 2005

Doug,

I'm sure most of us do the best for our patients.  I'll stick to my guns - 
anecdotally I have not seen any significant adverse effects on diagnosis due 
to titrated analgesia.  There are studies and metanalyses to back this up 
(see below).

I envy your snow.  Here it is hot and humid.

With best regards,

John

Dr John L Holmes
Director Emergency Medicine
Mater Adult Hospital,  Brisbane,  Australia

McHale PM, LoVecchio F.  Narcotic analgesia in the acute abdomen--a review 
of prospective trials.Eur J Emerg Med. 2001 Jun;8(2):131-6.

Withholding administration of narcotic analgesia in patients with acute 
abdominal pain for fear of masking pathology is still pervasive in current 
medical practice. We reviewed all the prospective trials that investigated 
the safety, adverse affects, and ultimate outcome in patients with acute 
abdominal pain receiving narcotic analgesia within the emergency department 
(ED). No adverse outcomes or delays in diagnosis could be attributed to the 
administration of analgesia. Based on this research, we propose that it is 
safe and humane to administer narcotic pain relief to patients presenting to 
the ED with acute abdominal pain provided no contraindications exist.

Thomas S.H.; Silen W. Effect on diagnostic efficiency of analgesia for 
undifferentiated abdominal pain.  British Journal of Surgery, January 2003, 
vol. 90, no. 1, pp. 5-9(5)

Abstract:

Background

The question of whether it is safe to provide analgesia for patients with 
undifferentiated acute abdominal pain is marked by longstanding controversy 
over the possible masking of physical findings. The goal of this review is 
to assess the pertinent studies.

Method

A Medline search was performed in April 2002, using the terms ‘analgesia’, 
‘abdominal pain’, ‘acute abdomen’ and ‘morphine’. Other articles were 
identified using the bibliographies of papers found through Medline. All 
articles reporting clinical trials of analgesia and its effects on diagnosis 
or physical examination were reviewed.

Results

A total of eight trials (one reported only as an abstract) were identified. 
Because of significant disparity in trial design, no formal analysis such as 
meta-analysis was performed. However, detailed review of the trials revealed 
a striking consistency in results. In no study was there an association 
between analgesia and diagnostic impairment or dangerous masking of the 
findings of physical examination.

Conclusion

The literature addressing early pain relief for abdominal pain is 
characterized by weaknesses, but there is a common theme suggesting that 
analgesia is safe. Pending further research, which should address some of 
the shortcomings of extant studies, a practice of judicious provision of 
analgesia appears safe, reasonable and in the best interests of patients in 
pain.

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