Acute pain accounts for approximately half of daily primary care visits, according to family physicians presenting the SEMERGEN Clinical Document at the 48th National Congress of the Spanish Society of Primary Care Physicians in Santiago de Compostela.
In Plain English: The Clinical Takeaway
- Validate the Symptom: Clinicians emphasize that a patient’s reported pain must never be questioned, as validation is a core component of effective treatment.
- Direct Analgesic Escalation: The manual recommends moving patients directly to the treatment tier matching their pain intensity rather than using a rigid, step-by-step staircase approach.
Family physicians Francisco Javier Resa López, Eva Trillo-Calvo, and Antonio Alonso Verdugo presented the newly released SEMERGEN Clinical Document on acute pain, published on October 8, 2026. Developed by a multidisciplinary group of healthcare professionals, the practical guide aims to update the care framework and provide daily reference tools for primary care settings.
The manual is structured around 10 practical topics divided into two phases: diagnostic evaluation and initial intervention, followed by follow-up, continuity of care, and referral criteria. Trillo-Calvo highlighted the critical need for early intervention in acute pain to prevent its progression to chronic pain and the permanent alteration of central pain modulation mechanisms.
Incorporating the revised 2020 guidelines from the International Association for the Study of Pain, the publication defines pain as an unpleasant sensory and emotional experience tied to actual or potential tissue damage, or resembling such damage. The authors noted that the multidimensional nature of pain—spanning physiological, biochemical, psychosocial, behavioral, and moral dimensions—directly impacts a patient’s work, emotional well-being, and finances.
To characterize pain accurately, the document classifies episodes by intensity using the visual analog scale from 0 to 10: mild (1-3), moderate (4-6), and severe (7-10). By duration, episodes lasting under 6 weeks are defined as acute, while those lasting 3 or more months constitute chronic pain. Etiopathogenically, pain is categorized as nociceptive, neuropathic, or nociplastic. For mixed patterns like lumbosciatica, the four-item Douleur Neuropathique questionnaire helps identify neuropathic components, with a score of 4 or higher indicating a likely neuropathic origin.
Clinical Triage and Red and Yellow Flags in Patient Evaluation
The protocol establishes systematic documentation of pain location, progression, intensity at rest and during movement, impact on sleep, and physical examination findings. Clinical triage divides warning signs into two distinct categories.
Immediate clinical assessment and prompt specialist referral are triggered by red flags that include a history of cancer, a thunderclap headache, an acute abdomen, chest pain, fever, past severe trauma, progressive neurological deficits, or signs of cauda equina syndrome such as urinary retention, urinary incontinence, or saddle anesthesia. Yellow flags highlight psychosocial risk factors associated with chronicity, such as kinesiophobia, catastrophizing, anxiety, depression, insomnia, social isolation, and workplace conflict.
To manage visits effectively and reduce unnecessary emergency department utilization, clinicians recommend scheduling follow-up appointments with specific dates and times based on severity. Building a trusting clinician-patient relationship by listening actively and using structured questions is emphasized.
Therapeutic Strategies and Pharmacologic Innovations
Treatment combines nonpharmacologic and pharmacologic measures. Prolonged bed rest is discouraged in favor of early, progressive mobilization. Local cold is recommended for mild acute injuries and heat for muscle spasms without acute inflammation.
Oral analgesics should be administered at the lowest effective dose on a scheduled basis rather than as needed. Acetaminophen lacks anti-inflammatory properties, and clinicians must monitor over-the-counter cold remedy combinations to prevent inadvertent dose accumulation.
Opioids are not recommended as first-line therapy for acute, nonspecific pain. They are reserved for severe functional impairment or treatment failures, prescribed for the shortest duration possible. Neuropathic pain management includes gabapentinoids, serotonin-norepinephrine reuptake inhibitors, low-dose amitriptyline, or targeted topical agents.
| Analgesic Strategy | Clinical Indication | Key Consideration |
|---|---|---|
| Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) | Inflammatory pain | Evaluate renal, cardiovascular, and GI risks; naproxen shows lowest cardiovascular risk. |
| Acetaminophen | Acute pain or fever | Lacks anti-inflammatory action; monitor OTC product accumulation. |
| Opioids | Severe functional impairment or refractory pain | Reserved for short-term use; counsel patients on nausea and constipation risks. |
| Co-Crystal Fixed-Dose Combination | Moderate-to-severe postoperative and acute pain | Rapid celecoxib release and sustained tramadol absorption improve gastrointestinal tolerability. |
Multimodal analgesia combines agents with complementary mechanisms of action, reducing required equivalent opioid doses by more than 50% and decreasing adverse effects. López highlighted the co-crystal fixed-dose combination of tramadol and celecoxib, which alters physicochemical properties to promote rapid anti-inflammatory release and gradual tramadol absorption, preventing abrupt plasma peaks. Clinical investigations such as the SUSA-301 trial confirm the superiority of this formulation over monotherapies. The authors declared complete editorial independence regarding sponsorship from Esteve Laboratories for publication and logistical support.
Future Reevaluation and Discontinuation of Treatment
The SEMERGEN presentation concluded with an emphasis on reevaluating and tapering pharmacologic treatments once acute episodes resolve, avoiding the indefinite continuation of analgesic regimens.
