This updated handbook is designed to improve the assessment and management of acute pain in emergency and pre-hospital settings across Europe. Developed under the auspices of EUSEM and the European Pain Initiative, it offers practical, evidence-based strategies tailored for first responders, paramedics, and emergency physicians.
Since our 2020 edition, the pain management landscape has evolved significantly, driven by the opioid crisis, advances in multimodal therapies, and the growing role of technology in clinical decision-making. Pain remains the most common reason for emergency attendance, yet its treatment is still inconsistent. These guidelines aim to address that gap with updated, safer, and more individualised approaches.
New in this edition is a refined alignment with the WHO framework. It encourages judicious opioid use, promotes non-opioid strategies, and emphasises repeated, structured pain assessment using validated tools. Special attention is given to vulnerable groups such as children, the elderly, and patients with cognitive or substance use disorders.
The handbook retains essential content from the previous edition, including pain physiology and assessment methods, and now includes updated clinical algorithms, decision aids, and guidance on integrating point-of-care technology.
Our goal is to promote more consistent, compassionate, and effective pain care rooted in evidence, equity, and clinical excellence.
On behalf of the European Pain Initiative, I extend my sincere thanks to the dedicated committee members and EUSEM colleagues who contributed to this important work.
Special thanks also to Aguettant for their unrestricted grant, which supported the development of this handbook.
Professor Saïd Hachimi-Idrissi
University of Ghent, Belgium
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