SAN FRANCISCO — The University of California, San Francisco published a review paper identifying non-opioid medications as alternatives for managing acute pain in emergency departments. The paper examined non-opioid medications available in a San Francisco hospital emergency department and reviewed existing medical literature for potential pain relief options.

The study provides recommendations for treating abdominal pain, back pain, chest pain, fracture pain, and headache. Acetaminophen and non-steroidal anti-inflammatory drugs like ibuprofen demonstrated potential for relieving abdominal pain, back pain, chest pain, fracture pain, and headache. Ketamine showed promise for chest pain. A serotonin norepinephrine reuptake inhibitor antidepressant also showed promise for back pain, and several types of antipsychotics showed promise for headache and abdominal pain.

Opioids are effective at reducing pain, but the first wave of the U.S. opioid crisis began in the 1990s following widespread prescription of the medications. Akash Shanmugam, a medical student and first author of the study, stated that the desire to reduce opioids should not lead to under-treating pain. Dr. Kathy LeSaint, an associate professor of emergency medicine and an author of the study, stated that the enzymes responsible for metabolizing opioids can have varying strengths in different people.

Shanmugam also said that Gabapentin, initially approved for epilepsy, is now used for neuropathic pain management. Neural circuits creating pain sensation are also involved in the emotional experience of pain and its associated distress. Neurotransmitters such as dopamine, serotonin, norepinephrine, and glutamate regulate mood and contribute to the sensation of pain. Gabapentin is thought to alter neurotransmitter release through its effect on calcium channels, and antidepressants and antipsychotics regulate neurotransmitters more directly.

LeSaint explained that in chronic pain conditions, the nervous system can become highly sensitive and antidepressants and antipsychotics might reduce this sensitivity. She also said that chronic pain is often linked to poor sleep, depression, anxiety, and fatigue. She stated that asking patients about their prior opioid experiences can help tailor pain regimens for specific patients and specific pain syndromes. Shanmugam added that explaining the overlap between pain mechanisms and the emotional understanding of pain can reassure patients.