Beyond the Ladder: A 10-Domain Cognitive and Operational Toolkit to Humanise and Implement Acute Pain Guidelines at the Bedside

Background

Although pain is among the most common reasons for emergency department (ED) attendance, oligoanalgesia remains a persistent global issue. While the 2026 EUSEM guidelines provide evidence-based pharmacological recommendations, translating these into the crowded ED environment is often constrained by systemic overcrowding and a traditional reliance on technical skills, with limited integration of human factors and nontechnical skills relevant to suffering. The objective of this position paper is to propose a practical, human-centred operational framework that bridges scientific guidelines with clinical realities.