Central   Journal of Cardiology & Clinical Research Cite this article: Abdikarim ABDI, Basgut B (2016) An Evidence-Based Review of Pain Management in Acute Myocardial Infarction. J Cardiol Clin Res 4(4): 1067. *Corresponding author Bilg e n Ba sg ut, De p a rtme nt o f C linic a l Pha rma c y a nd Pha rma c o lo g y, Ne a r Ea st Unive rsity, No rth C yp rus, Me rsin10, Turke y, Ema il: Submitte d: 02 June 2016 Accepted: 02 July 2016 Publishe d: 04 July 2016 Copyright © 2016 Ba sg ut e t a l. OPEN ACCESS Ke ywo rds • Pain management • Myo c a rd ia l infa rc tio n • Dysp no e a • Co ro na ry a the ro sc le ro sis Review Article An Evidence-Based Review of Pain Management in Acute Myocardial Infarction Abdikarim ABDI 1 and Bilgen Basgut 1,2 * 1 Department of Clinical Pharmacy, Near East University, Turkey 2 Department of Pharmacology, Near East University, Turkey Abstract Since the turn of the twentieth century, morphine, an opioid analgesic, has played an integral role in the management of pain in myocardial infarction (MI). This is attributed to morphine’s effect on reducing blood pressure, slowing heart rate, and relieving anxiety, which may decrease myocardial oxygen demand, added to the fact that morphine has been studied extensively in pain management in many settings. For this morphine kept considered amongst the frst line therapies and most effective for acute pain management in MI patients according to many guidelines. However, observational data suggest that morphine administration during acute myocardial infarction (AMI) may have negative consequences, while this practice also lacks supporting rigorous evidence or studies designed to assess the effect of morphine administration. Added to this recent evidence uncovered that morphine may impede gastrointestinal absorption of oral antiplatelet drugs important in reducing mortality in AMI. These observations permit a comprehensive evaluation of the rationality of administration of morphine in AMI, and whether better alternatives are available in currently used analgesics or by using a morphine non-interacting P2Y12 receptor inhibitor for AMI patients. In this review we discuss the rationality of morphine use according to recent evidence and the side effects and drug-drug interactions of morphine affecting MI patient with the present alternatives based on the fndings of experimental, observational and randomized clinical studies. INTRODUCTION Myocardial infarction (MI) is a major cause of mortality and disability worldwide. The term MI reflects cell death of cardiac myocytes caused by ischemia, as a result of a perfusion imbalance between supply and demand. It’s most obvious classical clinical symptoms include various combinations of chest, upper extremity, jaw, or epigastric discomfort on exertion or at rest [1]. The discomfort associated with acute myocardial infarction (AMI) usually lasts at least 20 minutes. Often, the discomfort is diffuse, not localized, not positional, not affected by movement of the region, and it may be accompanied by dyspnoea, diaphoresis, nausea, or syncope. Relief of stressful symptoms as chest pain is important, not only for patient well being, but also because stress induces systemic circulatory effect that may worsen the ongoing infarction [2]. Since 1923 when James MacKenzie first suggested use of morphine and chloroform for treating cardiac patients with bed rest until unconsciousness is achieved. Since then morphine has been considered as one of the first line medications recommended for pain control in AMI. This was attributed to morphine effect on reducing blood pressure, slowing heart rate, and relieving anxiety, which may decrease myocardial oxygen demand, added to the fact that morphine has been studied extensively in pain management in many other settings while opioids are generally considered the first line therapies and most effective for acute pain management [2,3]. Despite this, morphine use in the setting of AMI lacks supporting rigorous evidence or studies designed to assess the effect of morphine administration. Yet many international guidelines such as the American College of Cardiology, the American Heart Association, and the European Society of Cardiology guidelines recommend morphine administration as a standard therapy in pain management in AMI [4,5]. Added to the critique of lack of strong evidence, a large observational study in 2005 reported that the use of morphine either alone or in combination with nitroglycerin was associated