Treatment for Acute Pain: An Evidence Map [Internet]

Introduction Acute pain is a common ailment in the U.S. often treated with opioids. This technical brief maps the current evidence on pain treatments for select acute pain conditions (postdischarge postoperative pain, musculoskeletal pain, acute migraine, dental pain, renal colic, and acute pain associated with sickle cell disease). Methods We conducted Key Informant discussions to develop the context around the acute pain conditions, settings, and current clinical practice. We then conducted a systematic literature search to identify recent systematic reviews of sufficient quality that evaluated pain treatments for select acute pain conditions. We screened results and extracted relevant data into evidence tables. We subsequently searched for original research published after systematic review search dates. Results Key Informant discussions identified important issues regarding common acute pain conditions and treatments. Certain acute pain conditions have not received sufficient attention in rigorous comprehensive systematic review; for most types of acute pain, pain etiology is critical to selecting appropriate treatment; the value of acute pain assessments in guiding treatment decisions is unclear; and regional and health system level policies play a large role in treatment decisions. Our search for systematic reviews for pain treatments for priority acute pain conditions identified 1226 potentially relevant references, of which 527 underwent full text review. After supplemental searching and full text review, 110 systematic reviews met basic eligibility criteria. Most acute pain conditions had systematic reviews that met eligibility criteria, but few reviews were sufficiently rigorous and comprehensive. Few eligible reviews focused on specific settings except emergency departments for several acute pain conditions. Eligible reviews rarely addressed specific subpopulations such as racial and ethnic groups, rural residents, pregnant women, individuals with comorbidities, or those with a history of substance use disorder, overdose, or mental illness. Comparisons addressed by many systematic reviews often included opioids. Discussion Our discussions with Key Informants and review of the literature show that additional original research and up-do-date comprehensive systematic reviews would help inform treatment decisions for a wide variety of acute pain conditions.