REVIEW ARTICLE Treatment of acute abdominal pain in the emergency room: A systematic review of the literature C. Falch 1 *, D. Vicente 2 *, H. Häberle 3 , A. Kirschniak 1 , S. Müller 1 , A. Nissan 4,5,6 , B.L.D.M. Brücher 4,5,7 1 Surgery, University of Tübingen, Germany 2 Department of Surgery, Walter Reed National Military Medical Center, Bethesda, USA 3 Department of Anesthesiology, University of Tübingen, Germany 4 INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Academy®, Germany – Israel – Serbia – USA 5 Theodor-Billroth-Academy®, Germany – Israel – USA 6 Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel 7 Bon Secours Cancer Institute, Richmond, USA Correspondence Björn L.D.M. Brücher E-mail: b-bruecher@gmx.de Funding sources None. Conflicts of interest None declared. This paper contains original material that has not been previously published. * Equal contribution. Accepted for publication 12 December 2013 doi:10.1002/j.1532-2149.2014.00456.x Abstract Appropriate pain therapy prior to diagnosis in patients with acute abdomi- nal pain remains controversial. Several recent studies have demonstrated that pain therapy does not negatively influence either the diagnosis or subsequent treatment of these patients; however, current practice patterns continue to favour withholding pain medication prior to diagnosis and surgical treatment decision. A systematic review of PubMed, Web-of- Science and The-Cochrane-Library from 1929 to 2011 was carried out using the key words of ‘acute’, ‘abdomen’, ‘pain’, ‘emergency’ as well as different pain drugs in use, revealed 84 papers. The results of the literature review were incorporated into six sections to describe management of acute abdominal pain: (1) Physiology of Pain; (2) Common Aetiologies of Abdominal Pain; (3) Pre-diagnostic Analgesia; (4) Pain Therapy for Acute Abdominal Pain; (5) Analgesia for Acute Abdominal Pain in Special Patient Populations; and (6) Ethical and Medico-legal Considerations in Current Analgesia Practices. A comprehensive algorithm for analgesia for acute abdominal pain in the general adult population was developed. A review of the literature of common aetiologies and management of acute abdomi- nal pain in the general adult population and special patient populations seen in the emergency room revealed that intravenous administration of paracetamol, dipyrone or piritramide are currently the analgesics of choice in this clinical setting. Combinations of non-opioids and opioids should be administered in patients with moderate, severe or extreme pain, adjusting the treatment on the basis of repeated pain assessment, which improves overall pain management. 1. Introduction Treating acute abdominal pain in the emergency room (ER) is one of the most frequent tasks faced by sur- geons. Appropriate analgesia requires evaluation of the individual patient’s pain, as well as a broad base of knowledge of the pathophysiology of common causes of abdominal pain and the pharmacology of appropri- ate analgesic agents. Currently, there is no clear consensus regarding the timing of neither analgesia nor the type of analgesic medications that should be used to effectively manage acute abdominal pain. This uncertainty largely stems from concerns that pre- diagnostic analgesia may confound patient evaluation, particularly the abdominal examination. This paper is intended to provide physicians-in-training and expe- rienced surgical specialists with an overview of modern management of acute abdominal pain in adult © 2014 European Pain Federation - EFIC ® Eur J Pain •• (2014) ••–•• 1