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BEHIND THE MYTHS studies, one of which was the limited number of patients studied. In 2006 Sumant Ranji, et al, reviewed nine trials involving adults and three trials in children to see if the results of physical examinations were altered by opioid administration. They found patients who were given either 5–15 mg of morphine or equivalent amounts of normal saline. The studies found no signifcant differences in the groups in terms of accuracy of diagnosis, alterations in physical presentations or mistakes in treatments. Two of the "Medical malpractice lawyers are well aware of pain management standards." that while opioid administration might alter the physical examination fndings somewhat, there were no signifcant management errors, and no patient suffered major morbidity or mortality.7 In 2007 a Cochrane Review compared six randomized controlled trials contrasting opioid analgesia with no analgesia in adults with abdominal pain. These studies included 699 studies measured patient comfort and found signifcant improvements with opioid analgesia.8 Other studies have resulting in similar fndings in the pediatric and geriatric populations.9–11 EMS providers are bound by treatment guidelines that arise from varying sources. Some are bound by statemandated protocols and feld guides that may limit pain management; some are guided by regional consortiums that adopt protocols; some are governed by hospital-based guidelines; others are free to have their medical directors provide treatment guidelines as they see ft. Standardization is diffcult and probably unattainable. Yet in view of the existing evidence, a good argument can be made that lack of adequate pain management may be a breach of standard of care that can lead to claims for injury and damages. Medical malpractice lawyers are well aware of pain management standards and defciencies and should be expected to review the pain management aspects of any case they investigate. And patients may never forget being made to suffer because of a fawed system. Changing the attitudes of emergency providers about pain management proceeds at glacial pace. It will require the efforts of all concerned to improve EMS1303S For More Information Circle 17 on Reader Service Card 28 MARCH 2013 | EMSWORLD.com