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Despite several well-designed studies demonstrating the safety and efficacy of analgesics for treating patients with acute abdominal pain, and a lack of any evidence to the contrary, many of us still cling to Cope’s teachings from the 1920s and are reluctant to administer analgesia lest it obscure clinical findings. In a prospective, randomized, double-blind, placebo-controlled study, these authors compared pain reduction and diagnostic accuracy after administration of morphine analgesia (0.1 mg/kg IV; maximum dose, 10 mg) or placebo in 160 adults who presented to an emergency department with acute abdominal pain.
Patients rated pain on a 100-mm visual analog scale before and 15 minutes after administration of the study drug. Diagnostic accuracy was determined by comparing the initial diagnosis, made by an attending emergency physician based on a single physical examination 15 minutes after administration of the study drug, with the final diagnosis, obtained by follow-up 6 weeks after the ED visit.
The median decrease in pain score was 33 mm in the morphine group versus 2 mm in the placebo group. Diagnostic accuracy was 86% and 85% in the two groups, respectively.
Gallagher EJ et al. Randomized clinical trial of morphine in acute abdominal pain. Ann Emerg Med 2006 Aug; 48:150-60.
Comment
This study, along with others, confirms that administration of morphine analgesia to patients with acute abdominal pain reduces unnecessary suffering without hampering the accuracy of the physical exam. Simply put, no evidence supports the contention (often made by surgical consultants) that administration of opioid analgesia impairs the diagnosis of acute abdominal pain in any way. Dr. Cope was a great and talented physician and surgeon whose myriad contributions to medicine predated modern imaging, ultrasound, and virtually every other diagnostic modality in use today. It is time to move past this barbaric practice and accept the evidence about analgesics and the evaluation of the acute abdomen.