Medical myth: Analgesia should not be given to patients with an acute abdomen because it obscures the diagnosis.

Abstract

Surgical tradition holds that the use of analgesics should be withheld from patients with acute abdominal pain until a diagnosis and management plan have been established by a surgeon. This belief originated early in this century1 and was emphasized by Cope in his extremely influential book, Early Diagnosis of the Acute Abdomen. Cope claimed that analgesia would mask signs and symptoms, delay diagnosis, and lead to increased morbidity and mortality.2 In the most recent edition of Cope's book, Silen condemns the practice of withholding pain medication from a patient with acute abdominal pain. In the next sentence, however, he states that analgesia medication should be given only after a “responsible surgeon” takes a thorough history and performs a thorough physical examination. In actual practice, a surgeon is rarely the first physician to examine a patient with acute abdominal pain, and surgical consultation can take many hours. Given that all the evidence in the medical literature suggests that the use of narcotic analgesia does not obscure diagnosis—and may even improve diagnostic accuracy—in such patients, the traditional practice of withholding pain medication in patients with substantial pain should be seen as inappropriate and inhumane.