Clinical Practice Guideline: Alternatives to Opioids-Clinical Practice Guideline: Alternatives to Opioids

Clinical Practice Guideline: Alternatives to Opioids

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The Emergency Nurses Association's Clinical Practice Guideline (CPG) titled "Alternatives to Opioids" explores non-opioid analgesic strategies effective for managing specific types of acute pain in emergency department (ED) patients. The guideline acknowledges the risks associated with opioid use, such as dependence and overdose, and emphasizes the importance of considering non-opioid options.<br /><br />Acute pain management in the ED is critical given the potential for opioid misuse and interestingly, a significant proportion of opioid-related overdose deaths. The guideline recommends some effective non-opioid alternatives for specific pain types, such as renal colic, migraines, and musculoskeletal pain:<br /><br />1. **Renal Colic**: Non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are recommended as effective non-opioid options. Ketamine and lidocaine may also be beneficial but with weaker supporting evidence. Non-pharmacological methods like transcutaneous electrical nerve stimulation (TENS), heat patches, acupuncture, desmopressin, and magnesium show insufficient evidence for recommendation.<br /><br />2. **Migraine**: Metoclopramide, prochlorperazine, triptans, and NSAIDs (like ketorolac) are recognized as effective alternatives to opioids for migraine pain. Acetaminophen and magnesium might be helpful though evidence is limited. Dexamethasone, sodium valproate, and lidocaine are ineffective, whereas propofol, chlorpromazine, and dihydroergotamine (DHE) may work but have weaker evidence.<br /><br />3. **Musculoskeletal Pain and Trauma**: NSAIDs, acetaminophen, and ketamine were found effective for managing musculoskeletal pain. Although methoxyflurane may be effective, it's currently unavailable in the U.S. due to safety concerns. Evidence is insufficient for recommending nitrous oxide, local anesthetic blocks, or acupuncture.<br /><br />The guideline emphasizes that healthcare providers should integrate these alternatives into practice judiciously, considering individual patient circumstances and potential disparities in pain treatment due to race or ethnicity. The development involved a thorough review and analysis of existing literature, intending to assist ED practitioners in making informed decisions regarding non-opioid analgesics for acute pain management.

Keywords

Emergency Nurses Association

Clinical Practice Guideline

Alternatives to Opioids

non-opioid analgesics

acute pain management

emergency department

renal colic

migraine

musculoskeletal pain

opioid misuse