Article pour les cliniciens

Les interventions contre la douleur non pharmacologiques sont-elles efficaces pour réduire la douleur chez les patients adultes se rendant aux services d'urgences? Une revue systématique et méta-analyse.

  • Sakamoto JT
  • Ward HB
  • Vissoci JRN
  • Eucker SA
Acad Emerg Med. 2018 Aug;25(8):940-957. doi: 10.1111/acem.13411. Epub 2018 Apr 23. (Review)
PMID: 29543359
Lire le résumé Lire le texte intégral
  • Médecine d'urgence
    Relevance - 6/7
    Intérêt médiatique  - 5/7
  • Intérêt spécial - Douleur - Médecin
    Relevance - 6/7
    Intérêt médiatique  - 5/7
  • - Médecine physique et réadaptation
    Relevance - 5/7
    Intérêt médiatique  - 4/7

Résumé (en anglais)

OBJECTIVES: Pain is a common complaint in the emergency department (ED). Its management currently depends heavily on pharmacologic treatment, but evidence suggests that nonpharmacologic interventions may be beneficial. The purpose of this systematic review and meta-analysis was to assess whether nonpharmacologic interventions in the ED are effective in reducing pain.

METHODS: We conducted a systematic review of the literature on all types of nonpharmacologic interventions in the ED with pain reduction as an outcome. We performed a qualitative summary of all studies meeting inclusion criteria and meta-analysis of randomized controlled studies measuring postintervention changes in pain. Interventions were divided by type into five categories for more focused subanalyses.

RESULTS: Fifty-six studies met inclusion criteria for summary analysis. The most studied interventions were acupuncture (10 studies) and physical therapy (six studies). The type of pain most studied was musculoskeletal pain (34 studies). Most (42 studies) reported at least one improved outcome after intervention. Of these, 23 studies reported significantly reduced pain compared to control, 24 studies showed no difference, and nine studies had no control group. Meta-analysis included 22 qualifying randomized controlled trials and had a global standardized mean difference of -0.46 (95% confidence interval = -0.66 to -0.27) in favor of nonpharmacologic interventions for reducing pain.

CONCLUSION: Nonpharmacologic interventions are often effective in reducing pain in the ED. However, most existing studies are small, warranting further investigation into their use for optimizing ED pain management.

Commentaires cliniques (en anglais)

Emergency Medicine

This is an interesting topic and a methodologically rigorous study with important results. My only concern is that the studied interventions are often not feasible or accessible for many emergency department patients.

Special Interest - Pain -- Physician

This is very unlikely to be practice changing since substantial specialized resources are required to achieve the same result as non-addictive pharmaceuticals.

Voulez-vous savoir ce que lisent les professionnels? Inscrivez-vous pour accéder gratuitement à tous les contenus professionnels.