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Am Fam Physician. 2000;62(9):2122-2126

For patients undergoing an evaluation for an acute abdomen, it is typical to withhold opiate analgesic medication until a definitive diagnosis and plan of action has been made. Recently, this longstanding belief has been challenged. Studies suggest that the early administration of pain medication is safe and does not interfere with the ability to make an accurate diagnosis. Wolfe and associates examined the current practice patterns of analgesia administration among emergency department physicians when caring for a patient with an acute abdomen.

The authors prepared a one-page survey of factors that influenced a decision of when and whether to administer pain medication to patients with acute abdominal pain. The survey was mailed to 1,000 members of the American College of Emergency Physicians. The questionnaire was framed in the context of a patient presenting with acute abdominal pain requiring a surgical consultation. Questions in the survey included: “Does conservative use of narcotic pain medication mask important physical examination findings in these patients?”

Forty-four percent (443) of the surveys were completed. Fifty-seven percent of the respondents were residency trained in emergency medicine. The average annual emergency department census was 41,258. Of the physicians who responded, 377 (85 percent) felt that conservative administration of opiate pain medication did not change important clinical findings in patients with acute abdominal pain. However, the same number of respondents chose to administer an opiate analgesic only after surgical evaluation was completed.

In summary, although most providers do not feel that administration of pain medication masks important clinical findings, the majority of physicians wait until after the surgeon has completed the evaluation.

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