Abstract | BACKGROUND: Many patients who suffer from acute chest pain are transported by ambulance. It is not known how often treatment prior to hospital admission is optimal and how optimal pain-relieving treatment is defined. It is often difficult to delineate pain from anxiety. AIM: METHODS: In the literature search, we used PubMed and the appropriate key words. We included randomised clinical trials and observational studies. RESULTS: Four types of drug appear to be preferred: 1) narcotic analgesics, 2) nitrates, 3) beta-blockers and 4) benzodiazepines. Among narcotic analgesics, morphine has been associated with the relief of pain at the expense of side-effects. Alfentanil was reported to produce more rapid pain relief. Nitrates have been associated with the relief of pain with few side-effects. Beta-blockers have been reported to increase the relief of pain when added to morphine. The combination of beta-blockers and morphine has been reported to be as effective as beta-blockers alone in pain relief, but this combination therapy was associated with more side-effects. Experience from anxiety-relieving drugs such as benzodiazepines is limited. It is not known how these 4 drugs should be combined. The results indicate that various pain-relieving treatments might modify the disease. CONCLUSION: Our knowledge of the optimal treatment of chest pain and associated anxiety in the pre-hospital setting is insufficient. Recommendations from existing guidelines are limited. Large randomised clinical trials are warranted.
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Authors | Johan Herlitz, Angela Bång, Elmir Omerovic, Birgitta Wireklint-Sundström |
Journal | International journal of cardiology
(Int J Cardiol)
Vol. 149
Issue 2
Pg. 147-151
(Jun 02 2011)
ISSN: 1874-1754 [Electronic] Netherlands |
PMID | 21040986
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
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Copyright | Copyright © 2010 Elsevier Ireland Ltd. All rights reserved. |
Topics |
- Acute Coronary Syndrome
(complications, psychology, therapy)
- Anxiety
(complications, psychology, therapy)
- Chest Pain
(complications, psychology, therapy)
- Emergency Medical Services
(methods)
- Humans
- Treatment Outcome
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