Low Dose Ketamine (LDK) Versus Morphine for Acute Pain Control in the Emergency Department

Inclusion Criteria: * Patients age 18-59 who present to the Brooke Army Medical Center Emergency Department with acute (less than 10 days) abdominal pain, flank/lumbar back pain and or/pain to the extremities, and of sufficient severity in the judgement of the ED treating physician or PA to warrant use of intravenous opioids Exclusion Criteria: * Poor vital sign stability hypoxia: Sats\<95% hypotension: SBP\<90 hypertension: SBP\>180 heart rate: \<50 or \>120 respiratory rate: \<10 or \>30 * Altered mental status or intoxication * Patient is unwilling to participate or provide informed consent * History of chronic pain or pain syndrome with concurrent opioid medication use * fibromyalgia * Patient has received opioids and/or tramadol in the past 4 hours * Prescription pain medication use (to exclude muscle relaxants, acetaminophen or NSAIDs including toradol) in the past 4 hours * Allergy to morphine or ketamine * Sole provider status * Adverse reaction to morphine or ketamine in the past * Patients, who in the opinion of the triage nurse, require immediate analgesic relief * Patient is female of child-bearing age and unable to provide urine or serum for HCG analysis in triage * Pregnancy or breast feeding * Presence of oxygen dependent pulmonary disease, liver cirrhosis or Renal disease requiring dialysis. (as assessed by electronic chart review) * Presence of Ischemic heart disease, heart failure or unstable dysrhythmias (as assessed by electronic chart review) * Presenc…