It's pretty common practice to give a dissociative agent with an analgesic. That way, your pain goes away, and you don't have to remember being in pain. It's more common to give midazolam, than alprazolam though. I've never seen that drug in protocols. And it's perfectly legitimate to give fent for a shoulder dislocation in the acute setting. The problem comes when they over prescribe you afterward. Most doctors are moving away from that now though. I always push zofran(anti nausea/emetic drug) before giving fentanyl to a patient though. There are a shitload of factors that go in to what treatment pathway I go down though. Not all medications are for all people. A lot of acute care services are switching over to ketamine, which, in my opinion, is probably the way to go. It doesn't drop blood pressure, it doesn't suppress respiratory effort, and it can be used for pain management, people who are high as fuck on other crazy drugs, or to induce a temporary coma on people who can't control their own airway.