Category: Adult Analgesia

Analgesia and Abdo Pain

Question#: 528


With regards to Adult Analgesia. Does the standing order allow for Advanced Care Paramedics to treat generalized abdominal pain, with Morphine, Fentanyl or Ketorlac?? I am referring specifically to generalized abdominal pain or epi gastric pain.


Historically, there has been a concern around masking unknown surgical symptoms with analgesia when patients were presenting with abdominal pain, but with supportive evidence this ‘myth’ was turned.

This is why the indication in the Analgesia Medical Directive is “Pain”.

We recognize that pain is an important symptom and is currently under-treated in acute care (both out-of-hospital and hospital).

However, treatments must be considered with a risk/benefit approach. Some of the risks in providing analgesia for abdominal pain lie with root cause of the pain. An example would be the possibility of AAA or bleeding and the administration of ketorolac. Renal impairment or older populations also increase the risk of GI bleeding when administering Ketorolac or Ibuprofen.

The reason renal colic is specifically listed and highlighted is that there is good evidence of ketorolac and ibuprofen in the treatment of pain in renal colic.

Morphine and Fentanyl have their own risks and benefits. For example, risks of hypotension and sedation, patient’s age, first-time opioid use, etc. should be considered when administering opioids.

We believe paramedics have the knowledge, education and ability to make good risk benefit assessment of the patient presentation and apply the most appropriate tools to alleviate pain, including pharmacological and non-pharmacological (ex: ice, splinting, therapeutic communication, etc.) options.

The consultation line is available for you to consult with a BHP if you have questions or would like to run by your risk benefit assessment by them.

The root cause for abdominal pain can be difficult to diagnose, but pain is an important symptom that can be managed with different options in your toolkit.

As along as your risk/benefit assessment is done and documented, the RPPEO supports pain management of our patients in the community.

Specific to documentation as it relates to patient-centered care, the following information on the ePCR would help us provide more guidance to Paramedics and system, and continue improving quality and patient safety: clinical picture, pertinent +/-, rationale supporting your management plan and outcomes after managing pain using non-pharmacological and pharmacological options.

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