Fire EMS

Sublingual Opiate as Effective as IV Morphine for Treating Pain in the ER

WASHINGTON – Pain management in the emergency department just got easier to swallow, according to the results of a double-blind, randomized clinical trial published online last Wednesday in Annals of Emergency Medicine

Researchers found buprenorphine administered under the tongue manages pain just as effectively and safely as intravenous morphine. See “Sublingual Buprenorphine in Acute Pain Management: A Double-Blind Randomized Clinical Trial”.

“Buprenorphine was as effective as morphine in pain relief and had a better safety profile,” said lead study author Mohammed Jalili of Tehran University of Medical Sciences in Tehran, Iran.  “It is easier to administer and most patients would rather dissolve a pill under their tongue than have a needle put into their arm, especially when they are already in agony because of a bone fracture.  Nurses also prefer it.”

Patients with acute extremity fracture and a pain numeric score higher than 3 out of 10 were randomly assigned to receive either 0.4 milligrams of sublingual buprenorphine tablets or 5 milligrams of intravenous morphine. Pain scores were similar between the two groups at 30 minutes and 60 minutes after administration.  Frequency of nausea and dizziness were similar in the two groups.  The morphine group had a higher rate of hypotension.

Undertreatment of pain, or oligoanalgesia, is a common problem in the hectic, overcrowded environment of many emergency departments. Morphine is the standard analgesic in acute pain management in the emergency department, but it has potential to cause respiratory depression, central nervous system depression, hypotension and gastrointestinal problems.

“Buprenorphine is not routinely used in emergency departments,” said Dr. Jalili. “However, our study shows it to be a promising alternative to intravenous morphine for acute pain management.”

About Annals of Emergency Medicine

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, a national medical society. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

For more information visit