A physician’s care of acute traumatic injury begins with assessing problems with circulation or respiration and restoring or stabilizing normal functions. In many cases, emergency medical technicians have begun this process at the scene of an injury. They may apply cervical collars, spinal bracing, splints or other devices as needed.

Certain pain medications may not be administered to patients for fear of causing further unforeseen complications when life-saving techniques are required. For instance:

• Some analgesics (painkillers) may complicate breathing patterns under certain conditions.
  
  
• Neurological or abdominal exam results can be incorrectly interpreted if the patient is oversedated.
  
  
• Opioids can cause a patient’s condition to worsen in cases of head injury if not carefully administered.
  
  
• Certain medications cannot be mixed if patient is intoxicated with alcohol or any other recreational or illegal drug, which sometimes happens in trauma.

As a result, the challenges associated with treating patients with injuries resulting from acute (sudden, short-term) trauma can often lead to inadequate pain treatment.

Once a patient suffering from acute traumatic injury is stabilized, a more complete care plan can be established and medication for pain control can be administered. Minimizing trauma pain (pain from an injury or wound caused by external force or violence) is an important step to patient recovery. Usually the definitive treatment is the treatment of the underlying problem causing the pain. Successfully isolating and treating trauma pain minimizes discomfort and often results in shorter hospital stays, fewer complications and lower mortality rates.

The amount of treatment needed varies greatly according to the extent of the injury. For example, rest may be recommended for a concussion, though monitoring is essential to ensure that the condition does not worsen. A more extensive head injury or a spinal cord injury may require extensive rehabilitation.

A variety of analgesic and anti-inflammatory medications may be used to help relieve trauma pain, including:

• Intravenous (I.V.) opioids. I.V. opioids are the most popular form of analgesic for treating severe trauma pain. They are administered by inserting a needle into a patient’s vein. A plastic tube called a cannula may be attached to the exterior of the skin to avoid multiple injections. I.V. opioids can be given to patients more consistently as opposed to on demand. I.V. opioids more efficiently reduce pain than other methods as a result.
  
  
• Epidural. Pain medicine administered through an injection in the spinal column. Newer improvements in procedure, equipment and pharmacologic science have made the use of epidural analgesia (pain relief) commonplace for treating certain types of trauma pain (e.g., blunt injury to the chest wall. 
  
  
• Patient-controlled analgesia (PCA). Used in conjunction with I.V. opioids, PCA may be administered and controlled by the patient in certain instances when the patient is sufficiently alert. The patient can receive a predetermined dose of medicine when pain relief is necessary by pressing a button on a computerized pump that is connected to a small tube in the body. Patients cannot take the medicine while sleeping, thus making them less susceptible to respiratory depression and extreme drowsiness.
  
  
• Ibuprofen. Found in many over-the-counter drugs, ibuprofen helps reduce pain and inflammation.
  
  
• Aspirin. This common household drug can be used to reduce pain, fever, inflammation and blood clotting. It works by interfering with the transmission of pain signals to nerve endings.
  
  
• Acetaminophen. This is a drug that reduces pain and fever, but not inflammation.
  
  
• Oral opioids. These are rarely administered to patients incapacitated from traumatic pain. Oral opioids put the patient at high risk for aspiration (inhalation of food or liquid into the lungs) if they are not fully alert or if they have difficulty swallowing as a result of their injury. However, certain types of opioid medications may be prescribed for home use to help alleviate trauma pain when appropriate.
  
  
• Intramuscular (IM) opioids. Introduced to the body by muscular injection, IM opioids are absorbed slowly and tend to relieve pain rather slowly as well. They can also cause discomfort during administration. As a result, these tend to be used infrequently.
  
  
• Subcutaneous (SC) opioids. Similar to intramuscular opioids, subcutaneous opioids are slow in taking effect. Subcutaneous opioids are introduced to the body through the skin by injection, though not necessarily through muscle tissue. This method is not commonly used.

In addition, physicians may prescribe medications to be used at home as needed. The level of dosage and duration of use varies depending on the nature of the trauma pain itself.

Depending on the type of injury, pain management for  acute or chronic trauma may also include:

• Immobilization measures such as splints, casts or traction
  
  
• Therapy such as physical therapy, manipulation therapy or occupational therapy
  
  
• Modalities (physical agents) such as thermotherapy, cryotherapy, hydrotherapy or electrical therapy
  
  
• Injection therapy, such as nerve blocks or epidural corticosteroid shots
  
  
• Operations such as arthroscopy, arthroplasty, spine surgery or carpal tunnel release

• Psychotherapy or support groups, to cope with reactions such as post-traumatic stress