Acute Pain Management in Older Adults in the Emergency Department Ula Hwang, MD, MPH a,b,c, *, Timothy F. Platts-Mills, MD d,e INTRODUCTION Acute pain is a common reason for emergency department (ED) visits among older adults. 1 Effective treatment of acute pain is important for the relief of suffering and because unrelieved acute pain is associated with poorer outcomes during hospitaliza- tion, including persistent pain, longer hospital lengths of stay, missed or shortened physical therapy sessions, delays to ambulation, and delirium. 2–7 Despite the frequency with which this problem is encountered and the importance of effective pain treatment, disparities in pain care continue to exist for older adults when compared with younger adults as evidenced by high rates of pain at the end of the ED visit and lower rates of Disclosure: See last page of article. a Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY, USA; b Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY, USA; c Geriatric Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; d Department of Emergency Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC, USA; e Department of Anesthesiology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA * Corresponding author. Department of Emergency Medicine, One Gustave L. Levy Place, Box 1620, New York, NY 10029. E-mail address: ula.hwang@mountsinai.org KEYWORDS  Pain  Geriatrics  Emergency medicine  Pain assessment  Analgesics KEY POINTS  Effective treatment of acute pain in older patients is a common challenge faced by emer- gency providers.  Because older adults are at increased risk for adverse events associated with systemic analgesics, pain treatment must proceed cautiously.  Essential elements to quality acute pain care include an early initial assessment for the presence of pain, selection of an analgesic based on patient-specific risks and prefer- ences, and frequent reassessments and retreatments as needed. Clin Geriatr Med 29 (2013) 151–164 http://dx.doi.org/10.1016/j.cger.2012.10.006 geriatric.theclinics.com 0749-0690/13/$ – see front matter Published by Elsevier Inc.