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The NSAIDs and opioids figure prominently in the daily practice of EM. The gastrointestinal risks of NSAIDs are reduced by co-administration of gastroprotective therapy such as misoprostol or, preferably, proton pump inhibitors. The combination of NSAIDs and opioids fails to accrue additive (or synergistic) analgesic results. NSAIDs (and acetaminophen) will always claim one advantage over opioids: antipyresis. For most patients, the potential problems with opioids have little to do with efficacy in relieving pain. For short-term use as prescribed from the ED, the analgesic benefits of the opioids will counterbalance the risks foremost pregnant patients with pain uncontrollable by other means. Since most opioids are excreted to some degree in breast milk, opioids are best avoided in breastfeeding mothers. The controversy surrounding meperidine (pethidine) use in the ED is hard for acute care providers to avoid.
This chapter focuses on sore throat caused by viral or bacterial infection. It assumes that clinicians exercise appropriate precautions about airway management and possible complicating diagnoses. The NSAIDs, most commonly ibuprofen, are usually recommended for pain treatment of mild-to-moderate viral or bacterial pharyngitis (PG) in both adults and children. Aspirin, commonly dosed at 400-800 mg orally, is an effective PG pain reliever and is associated with symptomatic improvement. Acetaminophen is an effective reliever of mild pain, providing better PG relief than placebo within as little as 15 minutes. Corticosteroids, administered IM or PO in single or multiple doses, hasten the onset of both partial and complete pain relief in adults. In children, the utility of dexamethasone probably mirrors that of use of corticosteroids in adults with PG. Benzocaine (delivered by lozenges or spray) is commonly used for PG pain, but there are little applicable data for this indication.