Acute Abdominal Pain: Manage Without Delay

Chris Pasero, MS, RN-BC

Disclosures

August 02, 2013

Policy Statements and Guideline Recommendations

In 1994, the American College of Emergency Physicians published a clinical policy for the initial approach to patients with nontraumatic acute abdominal pain.[16] The policy was reviewed by the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Internal Medicine Center to Advance Research and Education Practice Guidelines Network, and it called for "early and appropriate use of analgesic medications" for acute abdominal pain. In 2001, the Agency for Healthcare Research and Quality questioned the practice of withholding analgesia, describing it as unsupported by evidence and "inappropriate and inhumane."[17]

The American Academy of Pediatrics underscores the importance of immediate triage, pain assessment, and pain treatment and reminds clinicians that the treatment of pain does not interfere with physical examination or diagnosis.[18] In Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain, the American Pain Society provides a rationale for the provision of pain relief during diagnosis: "When the cause of acute pain is uncertain, establishing a diagnosis is a priority. However, symptomatic pain treatment should be initiated as the diagnostic workup progresses. A comfortable patient is better able to cooperate with diagnostic procedures."[9]

Perhaps the most notable recommendation of all can be found in the most recent edition of Cope's Early Diagnosis of the Acute Abdomen, in which the current author of the monograph, William Silen, condemns the practice of withholding analgesia in patients with acute undifferentiated abdominal pain with the justification that it may interfere with diagnosis.[19]

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