Effectiveness of Standardized Pain Management Protocols for Acute Abdominal Pain in Emergency Departments: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
BACKGROUND: Acute abdominal pain constitutes a substantial proportion of emergency department (ED) presentations, yet pain management remains suboptimal due to historical concerns about masking diagnoses. This systematic review comprehensively evaluates standardized pain management protocols across diverse abdominal pathologies. OBJECTIVES: To assess the effectiveness of standardized pain management protocols compared to usual care in reducing time to analgesia and improving pain relief outcomes for adults presenting to EDs with acute abdominal pain of visceral, biliary, renal, or pelvic origin. METHODS: We systematically searched PubMed/MEDLINE, Cochrane Library, and Web of Science from January 1, 2000, to January 31, 2025. Eligible studies included adults (≥18 years) with acute abdominal pain in ED settings, comparing standardized protocols (nurse-initiated, clinical pathways, patient-controlled analgesia, multimodal approaches) to usual care. Primary outcome was time to first analgesia. Secondary outcomes encompassed pain reduction, patient satisfaction, guideline adherence, and diagnostic accuracy. Risk of bias was assessed using Cochrane ROB-2 for randomized controlled trials and Newcastle-Ottawa Scale for observational studies. Random-effects meta-analyses were conducted with comprehensive sensitivity analyses. RESULTS: From 621 identified records, 47 studies (n = 8347 patients) met inclusion criteria. Time to analgesia meta-analysis (15 studies, n = 3241) demonstrated substantial reduction with standardized protocols: pooled effect size d = 0.54 (95% confidence interval [CI]: 0.41-0.67), representing 42.7% reduction (37.3 minutes absolute). Pain intensity reduction (18 studies, n = 3892) showed significant improvement: standardized mean differences (SMD) -0.76 (95% CI: -0.89 to -0.63). Patient satisfaction improved consistently (12 studies, risk ratios [RR] 1.43, 95% CI: 1.28-1.59). Diagnostic accuracy remained unaffected (8 studies, RR 0.98, 95% CI: 0.94-1.02). Subgroup analyses confirmed benefits across all pathologies, including biliary and pelvic conditions specifically. CONCLUSIONS: Standardized pain management protocols demonstrate robust effectiveness in reducing time to analgesia and improving pain relief across all acute abdominal pathologies without compromising diagnostic accuracy. These findings definitively refute historical concerns and support immediate implementation in emergency departments globally.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.024 | 0.062 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.020 | 0.045 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".