Effectiveness of Standardized Pain Management Protocols for Acute Abdominal Pain in Emergency Departments: A Systematic Review and Meta-Analysis
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…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 8,347 participants or records.
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