Annals of Emergency Medicine
Volume 49, Issue 4 , Pages 445-453.e2 , April 2007

Randomized Double-Blind Placebo-Controlled Trial of Two Intravenous Morphine Dosages (0.10 mg/kg and 0.15 mg/kg) in Emergency Department Patients With Moderate to Severe Acute Pain

Received 6 April 2006 ,Revised 2 June 2006 ,Accepted 12 June 2006.

References 

  1. Schappert SM, Burt CW. Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 2001-02. Vital Health Stat. 2006;159:1–66
  2. Fosnocht DE, Heaps ND, Swanson ER. Patient expectations for pain relief in the ED. Am J Emerg Med. 2004;22:286–288
  3. Beel TL, Mitchiner JC, Frederiksen SM, et al. Patient preferences regarding pain medication in the ED. Am J Emerg Med. 2000;18:376–380
  4. Wilson JE, Pendleton JM. Oligoanalgesia in the emergency department. Am J Emerg Med. 1989;7:620–623
  5. Bijur PE, Kenny MK, Gallagher EJ. Intravenous morphine at 0.1 mg/kg is not effective for controlling severe acute pain in the majority of patients. Ann Emerg Med. 2005;46:362–367
  6. Aubrun F, Langeron O, Quesnel C, et al. Relationships between measurement of pain using visual analog score and morphine requirements during postoperative intravenous morphine titration. Anesthesiology. 2003;98:1415–1421
  7. Todd KH, Funk KG, Funk JP, et al. Clinical significance of reported changes in pain severity. Ann Emerg Med. 1996;27:485–489
  8. Gallagher EJ, Liebman M, Bijur PE. Prospective validation of clinically important changes in pain severity measured on a visual analog scale. Ann Emerg Med. 2001;38:633–638
  9. Bijur PE, Latimer CT, Gallagher EJ. Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department. Ann Emerg Med. 2003;10:390–392
  10. Kendrick DB, Strout TD. The minimum clinically significant difference in patient-assigned numeric scores for pain. Am J Emerg Med. 2005;23:828–832
  11. AHFS drug information. Available: http://www.online.statref.com/Document/document.aspx?DocID=1&StartDoc=1&EndDoc=1266&FxID=1&offset=7&sessionID=71C263NJIHVOIIXH. Accessed July 13, 2006.
  12. Bernstein SL, Bijur PE, Gallagher EJ. Relationship between intensity and relief in patients with acute severe pain. Am J Emerg Med. 2006;24:162–166
  13. Farrar JT, Portenoy RK, Berlin JA, et al. Defining the clinically significant important difference in pain outcome measures. Pain. 2000;88:287–294
  14. Ungar JR, Brandes D, Reinoehl BM. Pain management. In:  Schwartz GR editors. Principles and Practice of Emergency Medicine. 4th ed.. Baltimore, MD: Williams & Wilkins; 1999;
  15. Paris P, Yealy D. Pain management. In:  Marx JA editors. Rosen’s Emergency Medicine: Concepts and Clinical Practice. St. Louis, MO: Mosby; 2002;p. 2555–2577
  16. Zimmer G. Acute pain management. In:  Tintinalli J,  Kelen G,  Stapczynski J editor. Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2004;p. 257–264
  17. Lasagna L, Beecher H. The optimal dose of morphine. JAMA. 1954;156:230–234
  18. Green CR, Anderson KO, Baker TA, et al. The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Med. 2003;4:277–294
  19. Todd KH, Samaroo N, Hoffman JR. Ethnicity as a risk factor for inadequate department analgesia. JAMA. 1993;31:1537–1539
  20. Bijur PE, Schechter C, Esses D, et al. Intravenous bolus of ultra-low-dose naloxone added to morphine does not enhance analgesia in emergency department patients. J Pain. 2006;7:75–81
  21. Stahmer SA, Shofer FS, Marino A, et al. Do quantitative changes in pain intensity correlate with pain relief and satisfaction?. Acad Emerg Med. 1998;5:851–857
  22. Kelly AM. Patient satisfaction with pain management does not correlate with initial or discharge VAS pain score, verbal pain rating at discharge, or change in VAS score in the emergency department. J Emerg Med. 2000;19:113–116
  23. Kelly AM, Brumby C, Barnes BN. Nurse-initiated, titrated intravenous opioid analgesia reduces time to analgesia for selected painful conditions. Can J Emerg Med. 2005;7:149–154
  24. Coman M, Kelly AM. Safety of a nurse-managed, titrated analgesia protocol for the management of severe pain in the emergency department. Emerg Med. 1999;11:128–132
  25. Fry M, Holdgate A. Nurse-initiated intravenous morphine in the emergency department: efficacy, rate of adverse events and impact on time to analgesia. Emerg Med. 2002;14:249–254
  26. Turley E, Turley N, Robinson N, et al. Randomised controlled trial of patient controlled analgesia compared with nurse delivered analgesia in an emergency department. Emerg Med J. 2005;22:25–29

 Supervising editor: Steven M. Green, MDAuthor contributions: AB, DE, PEB, LH, and EJG conceived the study and designed the trial. DE supervised the conduct of the trial, the research associates, and data collection, including quality control. PB provided statistical advice on study design and analysis of the data. AB analyzed the data. PB conducted the interim analysis. AB drafted the article, and all authors contributed substantially to its revision. AB takes responsibility for the paper as a whole.Funding and support: The authors report this study did not receive any outside funding or support.Available online September 15, 2006.Reprints not available from the authors.

PII: S0196-0644(06)00885-7

doi: 10.1016/j.annemergmed.2006.06.030

Annals of Emergency Medicine
Volume 49, Issue 4 , Pages 445-453.e2 , April 2007