About EM Online

Since the late nineties of the previous century, a lot of research about pain management in the Emergency Department has been published. It seemed as if that was a turning point in time. From this point on, people started to realize the importance of (good) pain management in the Emergency Department. People started to understand that our patients deserved their pain to be treated well. Studies appeared. Some about pain assessment and documentation and some about the ideal route of analgesic administration. Many studies appeared about undertreatment of pain and a new expression was introduced; 'oligoanalgesia' and this is still in use today. But also, some studies appeared about presumed little risk of opioid addiction, when prescribing opioids.

Then, several official organizations, such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the American Society of Pain (ASP) and the International association for the Study of Pain (IASP) got involved. And all seemed well. Physicians, researchers and large organizations declared pain should receive more attention and pain got even called the fifth vital sign.

Eventually, pain prevalence, recognition, assessment, documentation and treatment were in the spotlight in the Emergency Department and hospital administrators got involved. Pain assessment and pain treatment became quality indicators, explicit incentives to treating pain well and treating it quickly.

However, in the meantime, Emergency Departments became busier and crowding increased. This meant there was less time and therefore less attention available for individual patients. Of course, this meant less time to treat pain well. All these factors taken together might have boosted opioid use in the Emergency Department back then and might have brought us where we are today.

Now, approximately 30 years later, we face an opioid epidemic. It seems that the pain treatment pendulum has swung to the opposite side. And we have to re-invent good pain management. 

Fortunately, the future is bright as multi-modal analgesia is getting more attention and regional anesthesia is finding its way to the Emergency Department.


With EM Online, my aim is to share the knowledge I have gained during my journey through available literature on pain management in the Emergency Department.

I hope I can share my thoughts and my conclusions with you and that you'll find your way across the website and its resources.

And of course, if you think more topics, studies, links or other information should be added, please let me know.

Enjoy, and learn!