Management of Mild to Moderate Pain from Triage to Discharge in the Emergency Department: A Multidisciplinary Delphi Consensus from the Italian Society of Emergency Medicine (SIMEU)

: Background: Mild and moderate pain represent a large proportion of emergency department (ED) presentations but are frequently underestimated and inconsistently managed, particularly in vulnerable populations such as children and older adults. Standardised and evidence-based approaches are needed to ensure timely, safe, and effective pain control across the entire emergency care pathway. Methods: A national multidisciplinary Delphi consensus was conducted under the auspices of the Italian Society of Emergency Medicine (SIMEU). A Scientific Steering Committee performed a systematic literature review and developed 26 statements comprising 92 items across four thematic areas: analgesia at triage, risk factors and analgesia at discharge, analgesia in children, and analgesia in elderly patients. Thirty-three experts from across Italy participated in three Delphi rounds, rating each item using a five-point Likert scale. Consensus was defined as ≥66% agreement (scores 4-5). Results: Consensus was achieved for 78 out of 92 items. Key recommendations include early pain assessment at triage using validated scales, paracetamol as first-line therapy for mild and moderate pain across all age groups, and the use of multimodal analgesia for moderate pain. Fixed-dose combinations of paracetamol and ibuprofen were strongly endorsed for their efficacy, safety, and opioid-sparing effect in adults, children, and elderly patients. Clear guidance was also provided for analgesic selection at discharge, duration of therapy, patient education, and management of special populations. Conclusions: This multidisciplinary Delphi consensus provides practical, evidence-based recommendations to harmonize the management of mild and moderate pain in ED. Implementation of these recommendations may improve pain control, patient safety, and quality of care in non-urgent emergency settings.