Clinical Acute Pain Management in Urgent Care Medicine Urgent message: Urgent care practitioners are called upon daily to alleviate pain. A thorough understanding of the various pain syndromes and the pharmacology and analgesic potencies of various medications will aid in their safe and appropriate use. Marc R. Salzberg, MD, FACEP and Paolo T. Coppola, MD, FACEP Introduction ain, either chronic or acute, is the main rea- son patients seek med- ical care. In this article, we will discuss acute pain management in an urgent care setting, calling on over 30 years of collec- tive experience in commu- nity emergency medicine and urgent care. For the purpose of this article, we will assume that the urgent care physician (UCP) has ordered and inter- preted the correct labs and radiological studies, made the correct diagnosis, and has reviewed the patient’s allergy history and current medica- tion usage. It is not the purpose of this article to address every possible pain syndrome. We will offer our strategies to effectively and correctly address the patient’s pain and expectations, while being mindful that meeting patients’ demand for pain medica- tion may actually not be in the patient’s—nor the physi- cian’s—best interest. w w w. j u c m . c o m © Images.com/Corbis P Rather, we will discuss anal- gesic equivalents, the appro- priate and limited use of opi- oid medication, drug-seeking behavior (how to recognize it and what to do about it), and, finally, give several real- case scenarios that occur fre- quently in an urgent care set- ting. (It should be noted that many “pain management” physicians often prefer the term opioid to narcotic, as it has less of a negative connota- tion. Technically, the terms are interchangeable, however.) Generally, it is the UCP’s responsibility to: Ⅲ Assess the quality and severity of pain. Ⅲ Identify pain that may represent a medical or surgical emergency. Differentiate acute vs. chronic pain. Assess pain that is the normal part of an injury or illness. Assess pain that may be the result of opioid depend- ence and its associated withdrawal symptoms. Identify drug-seeking behavior. Ⅲ Ⅲ Ⅲ Ⅲ JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | M a r c h 2 0 0 7 11