A Dosing and Efficacy Study of Intra-nasal Sufentanil for Moderate to Severe Pain

Inclusion Criteria: * 18 years old or older; * isolated traumatic injury to upper or lower extremity; * alert and oriented to name, date, place; patient has a numeric pain score of 5 or higher; * speaks English as their primary language; * female patients are on birth control, menopausal, or are sterile (hysterectomy, tubal ligation) Exclusion Criteria: * injury isolated to a finger or toe; * previous nasal or sinus surgery; chronic nasal problem; * acute nasal problem (ie epistaxis, upper respiratory infection, sinusitis); * pregnant; prisoner; allergy to sufentanil, fentanyl, or alfentanil; history of analgesic abuse or dependency; * presence of other painful injuries; systolic Blood Pressure less than 100 mm Hg; * patient seems or is confused or has a head injury; room air oxygenation less than 95%; * patient has chronic obstructive pulmonary disease, severe asthma, oxygen-dependent pulmonary disease; * impaired hepatic or renal function (obtained clinically or by history); * weight more than 230 lbs (100 kg); * alcohol or drug intoxication (per patient admission or clinical assessment of physician); * elderly (\> 70 years)