Prise en charge de la douleur aux urgences : mise au point

Recent data from the literature show that pain is inadequately supported in our emergency rooms, whatever the age of the consultants. In the elderly, the difficulty is increased due to the lack of prospective studies, which complicates assessment of their specific needs. The use of opioids is still weak, despite new molecules available, the old ideas persist, new reluctance arose. The spectrum of addiction reappeared across the Atlantic, intravenous morphine titration disappoints, hyperalgesia scares, chronic and neuropathic pain hold the emergency hits. New routes of administration of opioids are tested but are not yet reliable, the targeted etiological treatments have changed little. But the organizational responses to their promises, nursing home and guidance have become the new pillar of taking analgesic care for emergencies, new assessment in the pauci-communicating scores have been developed and are useful. In terms of pain caused, the situation is evolving in the right direction, modality of procedural sedation is becoming clear-cut. Finally, we are witnessing the emergence of new drugs versatile as ketamine, which provide solutions to various problems (hyperalgesia, intractable pain, conscious sedation). The new challenges of “qualitative” management of pain in addition to old “quantitative” goals, emergency have become “experts” in the acute pain management in their services, and increasingly in the literature.