Analgesics for Abdominal Pain
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Attard AR; Corlett MJ; Kidner NJ; Leslie AP; Fraser IA
Safety of early pain relief for acute abdominal pain [see comments]
BMJ, 305: 6853, 1992 Sep 5, 554-6
OBJECTIVES--(a) to determine the efficacy of papaveretum in treating pain
when administered early to patients presenting with acute abdominal pain and
(b) to assess its effect on subsequent diagnosis and management.
DESIGN--Prospective, randomised, placebo controlled study.
SETTING--Walsgrave Hospital, Coventry. SUBJECTS--100 consecutive patients
with clinically significant abdominal pain who were admitted as emergencies
to a surgical firm. INTERVENTIONS--Intramuscular injection of up to 20 mg
papaveretum or an equivalent volume of saline. OUTCOME MEASURES--Pain and
tenderness scores, assessment of patient comfort, accuracy of diagnosis, and
management decisions. RESULTS--Median pain and tenderness scores were lower
after papaveretum (pain score 8.3 in control group and 3.1 in treatment
group, p < 0.0001; tenderness score 8.1 in control group and 5.1 in
treatment group, p < 0.0001). Forty eight patients were deemed to be
comfortable after papaveretum compared with nine after saline. Incorrect
diagnoses and management decisions applied to two patients after papaveretum
compared with nine patients after saline. CONCLUSION--Early administration
of opiate analgesia to patients with acute abdominal pain can greatly reduce
their pain. This does not interfere with diagnosis, which may even be
facilitated despite a reduction in the severity of physical signs. These
patients should not be denied effective treatment.

Zoltie N; Cust MP
Analgesia in the acute abdomen.
Ann R Coll Surg Engl, 68: 4, 1986 Jul, 209-10
In a prospective sequential double blind trial 288 patients with acute
abdominal pain were given sublingual buprenorphine 200 mcg, sublingual
buprenorphine 400 mcg, or placebo. Pain relief was proportional to the
number of tablets administered; buprenorphine had no difference in effect
compared to placebo. Physical signs altered in proportion to dosage, but
this had no effect on clinical diagnosis. We conclude that patients with
acute abdominal pain may be given buprenorphine without fear of masking the
diagnosis.

Bergentz SE
[Analgesics in acute abdominal pain. Categorical prohibition is absurd]
Lakartidningen, 90: 34, 1993 Aug 25, 2741-2

Pace et. al.  Intavenous Morphine for Early Pain Relief in Patients with
Acute Abdominal Pain.  Acad EM  1996;3:1086-92