Clinician Article

Are Nonpharmacologic Pain Interventions Effective at Reducing Pain in Adult Patients Visiting the Emergency Department? A Systematic Review and Meta-analysis.

  • Sakamoto JT
  • Ward HB
  • Vissoci JRN
  • Eucker SA
Acad Emerg Med. 2018 Mar 15. doi: 10.1111/acem.13411. (Review)
PMID: 29543359
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  • Emergency Medicine
    Relevance - 6/7
    Newsworthiness - 5/7
  • Special Interest - Pain -- Physician
    Relevance - 6/7
    Newsworthiness - 5/7
  • Physical Medicine and Rehabilitation
    Relevance - 5/7
    Newsworthiness - 4/7


OBJECTIVES: Pain is a common complaint in the emergency department (ED). Its management currently depends heavily on pharmacologic treatment, but evidence suggests that nonpharmacologic interventions may be beneficial. The purpose of this systematic review and meta-analysis was to assess whether nonpharmacologic interventions in the ED are effective in reducing pain.

METHODS: We conducted a systematic review of the literature on all types of nonpharmacologic interventions in the ED with pain reduction as an outcome. We performed a qualitative summary of all studies meeting inclusion criteria and meta-analysis of randomized controlled studies measuring postintervention changes in pain. Interventions were divided by type into five categories for more focused subanalyses.

RESULTS: Fifty-six studies met inclusion criteria for summary analysis. The most studied interventions were acupuncture (10 studies) and physical therapy (six studies). The type of pain most studied was musculoskeletal pain (34 studies). Most (42 studies) reported at least one improved outcome after intervention. Of these, 23 studies reported significantly reduced pain compared to control, 24 studies showed no difference, and nine studies had no control group. Meta-analysis included 22 qualifying randomized controlled trials and had a global standardized mean difference of -0.46 (95% confidence interval = -0.66 to -0.27) in favor of nonpharmacologic interventions for reducing pain.

CONCLUSION: Nonpharmacologic interventions are often effective in reducing pain in the ED. However, most existing studies are small, warranting further investigation into their use for optimizing ED pain management.

Clinical Comments

Emergency Medicine

This is an interesting topic and a methodologically rigorous study with important results. My only concern is that the studied interventions are often not feasible or accessible for many emergency department patients.

Special Interest - Pain -- Physician

This is very unlikely to be practice changing since substantial specialized resources are required to achieve the same result as non-addictive pharmaceuticals.

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