Are non-pharmacologic pain interventions effective at reducing pain in adult patients visiting the Emergency Department? A Systematic Review and Meta-analysis

Abstract

Study Objective

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

Methods

We conducted a systematic review of the literature on all types of non-pharmacologic 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 post-intervention changes in pain. Interventions were divided by type into 5 categories for more focused sub-analyses.

Results

Fifty-six studies met inclusion criteria for summary analysis. The most studied interventions were acupuncture (10 studies) and physical therapy (6 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 9 studies had no control group. Meta-analysis included 22 qualifying randomized controlled trials and had a global standardized mean difference of -0.46 (95% CI: -0.66 to -0.27) in favor of non-pharmacologic interventions for reducing pain.

Conclusion

Non-pharmacologic 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

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