[The management of acute pain in ambulatory patients. The place of nefopam].

An emergency. When treating a patient, relief of any acute pain is a priority. Such pain should be treated as an emergency, rapidly and effectively. Assessment is the first step Pain is a subjective phenomenon. Assessment of its intensity is the first step to its management. Regarding treatment The molecules that can be used for the treatment of acute pain in ambulatory patients can be classified into two categories, co-analgesics (antispasmodics and non-steroidal antiinflammatories) and pure analgesics classified by the WHO into three grades, although this classification presents certain limits. Nefopam is a central analgesic, with non-opiate action and, because of this inscribed by the WHO in the first grade, but with an analgesic capacity that corresponds to the substances of grade II analgesics. Its efficacy relies on medullar and/or supramedullar mechanisms. Via intramuscular injection The delay before action is of around 10 to 20 minutes and lasts for around 6 hours. The advantages of intramuscular nefopam are its analgesic capacity, its simplicity of use and its tolerance. The indications In ambulatory patients, Acupan is administered during acute arthritic pain, post-trauma and dental pain, renal colic, extremely severe migraine and headaches, dysmenorrhoea, and intense spasmodic colic.