Pain management therapies used by non-physician emergency medical services clinicians: a scoping review with implications for education

Abstract Background Pain is a common reason for emergency medical services (EMS) utilisation, and effective pain management is a core responsibility of EMS clinicians. As EMS education increasingly occurs within higher education and clinicians assume broader, more autonomous roles, curriculum development requires an understanding of the therapies, contexts and patient populations represented in the evidence base. This scoping review aimed to map pain management therapies used by non-physician EMS clinicians and identify the operational settings, patient populations and pain types represented in the literature, to inform EMS competency and curriculum development. Methods The review was conducted in accordance with JBI methodology and reported according to the PRISMA extension for Scoping Reviews. Searches of MEDLINE (via PubMed), CINAHL, Scopus and Web of Science were conducted without date restrictions. Eligible sources comprised peer-reviewed primary and secondary studies in English reporting pain management therapies administered by non-physician EMS clinicians in prehospital settings. Data were charted and synthesised descriptively. The a priori protocol was registered on the Open Science Framework. Results Of 9,082 records identified, 152 evidence sources were included: 108 primary studies and 44 secondary studies published between 1972 and 2025. The evidence encompassed four non-pharmacological therapies, 16 pharmacological therapies, three procedural approaches and two enabling interventions, with research concentrated on opioids, ketamine, nitrous oxide and methoxyflurane. Most evidence originated from high-income countries, particularly the United States, United Kingdom, Australia and Canada, and predominantly concerned adults, acute traumatic pain and ground ambulance operations. Paediatric and older adult populations, obstetric, chronic and palliative pain, and low- and middle-income settings were sparsely represented. Intravenous, intranasal, inhaled and other needle-minimising routes were prominent contextual enablers of pain management. Conclusions The evidence on prehospital pain management is broad but unevenly distributed across therapies, populations and settings. The findings indicate that EMS pain management curricula should address not only individual therapies but also pain assessment and reassessment, clinical reasoning, route selection, contextual adaptation, communication, monitoring and multimodal care. This evidence map can inform competency development, curriculum design and priorities for future clinical and educational research in EMS pain management.