Non-invasive forms of pain control provide unique opportunities for EMS clinicians at all levels. They can allow providers who have never had a pharmacological approach to pain control before to start pain management before advanced care arrives or the patient is taken to the emergency room. Even for advanced providers, non-invasive pain control has several benefits. These forms of noninvasive pain control can be activated faster than other forms of pain control, which require time-intensive preparation. For advanced providers, non-invasive pain control may be a good first step before deploying more traditional forms of pain treatment. Regardless of the specific use case, EMS departments and other agencies that provide emergency medical care will benefit from examining whether non-invasive forms of pain control are likely to play a role in how they respond to service requests involving pain.

In 2002, Borland and colleagues wrote that “pre-hospital analgesia is an area that deserves innovative methods to manage safe and effective analgesics without significantly affecting transit time”1. In the past, written statements in research journals have proven to be persuasive tools2 Pain-related emergencies are some of the most common reasons for individuals seeking medical assistance in emergency rooms, and estimates indicate that approximately one-third of emergency medical services nationwide (EMS) activities involve some form of pain.3,4 Medications are often used in prehospital settings for patients who require pain management. 5,6

Many people attribute the birth of prehospital pain control to Baskett & Withnell (1970) in the United Kingdom, who described the use of a gas mixture of nitrous oxide and oxygen in 66 severe pain patients over a period of three and a half months. In all patients, they reported that some or all pain relief was achieved without any adverse reactions. 7 Only a few years later, their gas mixture is commonly used in the pre-hospital environment. 8 Since then, other pain control methods have been adopted by the EMS agency.

The main categories of medications used to control pain before hospitalization include opioids, NMDA receptor antagonists, benzodiazepines, non-steroidal anti-inflammatory drugs, and non-opioid pain relievers. 4 Of these, opioids (such as morphine and fentanyl) are the most common-9 They are mainly administered intravenously (IV) or intramuscularly (IM). 4

Currently, many people believe that pain control is a necessary condition for ambulances that can operate at the Advanced Life Support (ALS) level. 10 Having said that, the main route of administration used for many forms of medication pain therapy limits the people who have the right to use them. Many providers are hampered by the inability to provide effective medication pain control, especially those who respond to 911 calls without contacting senior providers in time. However, this need not be the case. Pain management drugs have been shown to be successfully delivered through alternative, less invasive routes. Adding less invasive routes of administration may enable a wider range of providers to safely manage pain with medications. For example, drugs can be administered via nasal sprays, buccal (cheek) tablets, inhaled gas, or skin patches. 12 These additional pain control routes of administration have the potential to improve patient care.

Opioids are one of the most commonly used drugs in the pre-hospital setting. They are traditionally administered intravenously or intramuscularly, and many people are concerned about the possibility of a fatal response from the provider's error-these considerations mean that their use is not widespread. However, opioids can be administered transmucosally: one option is a lozenge-style lozenge that can be placed in the patient's mouth, while another option is intranasal administration. 14

Compared with traditional opioid administration, non-invasive opioids have many advantages. Unlike doses administered intravenously or intramuscularly, transmucosal opioids administered via lollipops can be titrated based on effectiveness or any adverse reactions. For example, if the provider notices a decrease in the patient's alertness level, they can remove the delivery device before a dangerous reaction occurs and provide opioid reversal if needed. The use of oral transmucosal fentanyl citrate has been fully demonstrated in military settings and pediatric patients. 15-18

Intranasal administration has been extensively studied in emergency situations. This route of administration is effective because of the highly vascularized and communicative nature of the tissue lining the nasal passages. 19 One of the main benefits of intranasal pain medication administration is to reduce the time required for administration. A study that directly compared intravenous opioids and intranasal opioids in the emergency room found that patients were able to administer intranasal fentanyl more quickly than intravenous opioids, and the number of adverse reactions between the two groups was not significant. The difference. 20 Another study tested intranasal fentanyl in pediatric patients undergoing EMS treatment and found that the drug “appears to be a safe and effective analgesic in the prehospital management of acute severe pain in children, and may be oral And an attractive alternative to intravenous opioids.” twenty one

The ease of deployment associated with non-invasive painkillers means that non-ALS-level units--including BLS-equipped ambulances, non-transportation firefighting equipment, and law enforcement agencies--can initiate effective pain control before or before the arrival of ALS-level units. Take it to the emergency room. In communities with limited resources at the ALS level, the non-invasive pain control management of the BLS unit may reduce the workload of the ALS unit and reduce the time that trauma patients may experience severe pain. The successful deployment of non-invasive pain control at the BLS level depends on adequate training and, in the case of potent opioids, the ability to quickly reverse any adverse effects of the drug if needed. Of course, providers should also receive training in drug pharmacodynamics and specific indications and contraindications.

Although the main attraction of non-invasive pain control may be its use by non-advanced providers, it may still be possible for non-invasive forms of pain management to play a unique role in ALS-level care. Preparing for many current forms of pain control may require providers to spend a lot of time formulating medications, ensuring they have the correct dosage, preparing drug delivery equipment, and obtaining intravenous or intraosseous access (in some cases). When preparing for other forms of pain control, noninvasive pain control may be able to initiate and provide relief to the patient. Alternatively, non-invasive pain control can be used in situations that do not require large amounts of medication, or it is not in the patient's best interest to spend time establishing vascular access in "load and operating conditions."

The form of non-invasive pain control brings interesting benefits to EMS providers on multiple levels. First, their ease of use may allow providers who previously had no access to pain control medications to use them. Second, these same characteristics may make them valuable additional tools for advanced providers, who may choose to use them in specific situations rather than more invasive forms of pain control. Further research, such as prospective clinical trials comparing current and non-invasive forms of pain control, may provide additional convincing evidence for its adoption.