Abstract
Appropriate pain therapy prior to diagnosis in patients with acute abdominal
pain remains controversial. Several recent studies have demonstrated
that pain therapy does not negatively influence either the diagnosis or
subsequent treatment of these patients; however, current practice patterns
continue to favour withholding pain medication prior to diagnosis and
surgical treatment decision. A systematic review of PubMed, Web-ofScience
and The-Cochrane-Library from 1929 to 2011 was carried out
using the key words of ‘acute’, ‘abdomen’, ‘pain’, ‘emergency’ as well as
different pain drugs in use, revealed 84 papers. The results of the literature
review were incorporated into six sections to describe management of
acute abdominal pain: (1) Physiology of Pain; (2) Common Aetiologies of
Abdominal Pain; (3) Pre-diagnostic Analgesia; (4) Pain Therapy for Acute
Abdominal Pain; (5) Analgesia for Acute Abdominal Pain in Special Patient
Populations; and (6) Ethical and Medico-legal Considerations in Current
Analgesia Practices. A comprehensive algorithm for analgesia for acute
abdominal pain in the general adult population was developed. A review
of the literature of common aetiologies and management of acute abdominal
pain in the general adult population and special patient populations
seen in the emergency room revealed that intravenous administration of
paracetamol, dipyrone or piritramide are currently the analgesics of choice
in this clinical setting. Combinations of non-opioids and opioids should be
administered in patients with moderate, severe or extreme pain, adjusting
the treatment on the basis of repeated pain assessment, which improves
overall pain management