NEUROSCIENCE: Edited by Marek A. MirskiPain management in neurocritical care; an updateMorad, Athira; Farrokh, Saliab; Papangelou, AlexandercAuthor Information aDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine bDepartment of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland cDepartment of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA Correspondence to Athir Morad, MD, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, 600 N Wolfe Street, Phipps 455, Baltimore, MD 21287,USA. Tel: +1 410 955 2611; e-mail: firstname.lastname@example.org Current Opinion in Critical Care: April 2018 - Volume 24 - Issue 2 - p 72-79 doi: 10.1097/MCC.0000000000000480 Buy Metrics Abstract Purpose of review Pain management in neurocritical care is a subject often avoided because of concerns over the side-effects of analgesics and the potential to cause additional neurological injury with treatment. The sedation and hypercapnia caused by opioids have been feared to mask the neurological examination and contribute to elevations in intracranial pressure. Nevertheless, increasing attention to patient satisfaction has sparked a resurgence in pain management. As opioids have remained at the core of analgesic therapy, the increasing attention to pain has contributed to a growing epidemic of opioid dependence. In this review, we summarize the most recent literature regarding opioids and their alternatives in the treatment of acute pain in patients receiving neurocritical care. Recent findings Studies on pain management in neurocritical care continue to explore nonopioid analgesics as part of a multimodal strategy aimed at decreasing overall opioid consumption. Agents including local anesthetics, acetaminophen, ketamine, gabapentinoids, and dexmedetomidine continue to demonstrate efficacy. In addition, the prolonged longitudinal course of many recent trials has also revealed more about the transition from acute to chronic pain following hospitalization. Summary In an era of increasing attention to patient satisfaction mitigated by growing concerns over the harms imposed by opioids, alternative analgesic therapies are being investigated with promising results. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.