Pain is considered to be the most common cause of distress of patients seeking care in the emergency departments [1]. This brings a lot of pressure on the emergency personnel in their efforts to manage acute pain adequately and proficiently, even in the prehospital setting. Due to a large variation between both the patients and the conditions, the optimal pain management in these varying situations is quite challenging. Pain management is complicated by the lack of information which would be necessary for the individual treatment of pain. Pain experiences also vary because of differences in age, gender, clinical situation and context, previous experiences, present expectations and a host of other psychological and physiological conditions. Personal characteristics and emotional reactions also play a major role in the way an individual reacts to pain on these occasions, which often occur abruptly and unexpectedly. Thus, perceived pain is not always proportional to the intensity of the tissue damage or the undesirable stimulus. In order to further develop pain management in the field of emergency medicine, there is obviously a need for systematic reviews in this area.
In the current issue of the Scandinavian Journal of Pain Niemi-Murola et al. present a systematic review of the efficacy and safety of parenteral opioids used in the emergency medicine [2]. This qualitative review neatly collects the relevant literature documenting the number of studies in this area and describes the incidence of opioid-related adverse drug reactions. The main outcome measures of this qualitative review of randomized controlled trials on parenteral opioids for acute pain treatment in adult emergency patients were the type and dose of opioids, analgesic efficacy and adverse effects. Twenty double-blind randomized controlled trials with results from 2322 patients were finally included in the current systematic review. The majority of the studies included were performed in the emergency department. Only five of them were carried out in the prehospital setting. However, the studies that took place outside the hospital are the most interesting ones, since they are scarce. The main part of the studies dealt with acute abdominal pain. In four out of five studies on abdominal pain the opioid administered did not change diagnostic, clinical DOI of refers to article