Developing an Evidence-based Approach to Prehospital Pain Management

NHTSA Office of EMS partners with Agency for Healthcare Research and Quality (AHRQ) to research and develop guideline for treating pain

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The opioid crisis has raised questions about the best way to address patients’ pain in the field. While there’s no evidence tying prehospital administration of narcotics to addiction or overdose deaths, finding alternatives to managing pain could reduce the amount of opioids in the field. At the same time, it is critical that patients’ pain is not ignored, and safe and effective treatments are available to EMS clinicians.

To help address the issue, the NHTSA Office of EMS is working with AHRQ experts to examine the research and evidence related to prehospital management of acute pain by EMS. AHRQ has selected researchers at the University of Connecticut Evidence Based Practice Center to steer the effort, which will result in a report that will be used to update the evidence-based guidelines for prehospital analgesia in trauma. That EBG was originally published online in 2013.

“Alleviating patients’ pain and suffering is not only the right thing to do, but it is a central tenet of the people-centered vision that is described by EMS Agenda 2050,” said Jon Krohmer, MD, director of the NHTSA Office of EMS. “We’re proud to collaborate with our federal, state and local partners to develop evidence-based guidelines for EMS clinical care to ensure patients across the country have access to the best possible treatment and outcomes.”

The first step of developing the report was to create a research protocol, which was completed and published in October. Next steps will include an analysis of the literature and evidence in order to address the following questions:

  • What is the comparative effectiveness of the initial analgesic agent treatment for achieving reduction in moderate-to-severe acute-onset pain level when administered by EMS personnel in the prehospital setting?
  • What are the comparative harms of analgesic agents when administered by EMS personnel to control moderate-to-severe pain in the prehospital setting?
  • In patients whose moderate-to-severe acute-onset pain level is not controlled following initial analgesic treatment, what is the comparative effectiveness of switching the analgesic regimen compared to repeating the initial treatment?
  • In patients whose moderate-to-severe acute-onset pain level is not controlled following initial analgesic treatment, what are the comparative harms of switching to another analgesic agent?

An initial draft of the report is expected this spring, at which time AHRQ will seek public feedback prior to publishing a final report in the summer of 2019.