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Presented by:12400 High Bluff DriveSan Diego, CA 92130
This course has been awarded four (4.0) contact hours.This course expires on September 22, 2010.
Copyright © 2004 by RN.com.All Rights Reserved. Reproduction and distributionof these materials are prohibited without theexpress written authorization of RN.com.
First Published: October 27, 2004 Revised Date: September 22, 2007
Acute and Chronic Pain: Assessment and Management 
 
 2
Acknowledgements____________________________________________________________4
 
Purpose & Objectives__________________________________________________________5
 
Defining Pain__________________________________________________________________6
 
Categorizing Pain Types________________________________________________________6
 
Nocioceptive Pain______________________________________________________________6
 
Neuropathic Pain______________________________________________________________7
 
Acute Pain versus Chronic Pain__________________________________________________7
 
Summary of Pain Types_________________________________________________________7
 
Barriers to Effective Pain Assessments and Management____________________________8
 
Patient Barriers________________________________________________________________8
 
Healthcare Professional Barriers_________________________________________________8
 
Health System Barriers_________________________________________________________8
 
Addressing Barriers to Pain Relief________________________________________________9
 
Minimizing Barriers____________________________________________________________9
 
Fears about Addiction__________________________________________________________9
 
Fears about Opioid Tolerance and Physical Dependence____________________________10
 
Exaggerating Fears Related to Respiratory Depression_____________________________10
 
Principle of Double Effect______________________________________________________10
 
Misconception that the Doctor or Nurse Knows Best_______________________________11
 
Impact of the Nursing Shortage on Pain Management_______________________________11
 
JCAHO Standards____________________________________________________________11
 
Pain Assessment_____________________________________________________________12
 
Provocation or Palliative Symptoms_____________________________________________12
 
Quality______________________________________________________________________12
 
Radiation____________________________________________________________________13
 
Severity_____________________________________________________________________13
 
Timing______________________________________________________________________13
 
Physical Examination: Inspection_______________________________________________13
 
Physical Examination: Auscultation_____________________________________________14
 
Physical Examination: Palpation and percussion__________________________________14
 
Summary of Assessment Findings______________________________________________14
 
Communicating Assessment Findings___________________________________________14
 
Case Discussion______________________________________________________________16
 
Pain Management_____________________________________________________________18
 
Understanding Opioids________________________________________________________18
 
 
 3
Non-Opioid Analgesia: Acetaminophen and NSAIDs________________________________24
 
COX-2 Inhibitors______________________________________________________________26
 
Adjuvant Analgesia___________________________________________________________26
 
Non-pharmacological Therapies_________________________________________________27
 
The WHO Ladder to Manage Chronic Malignant Pain_______________________________28
 
Special Populations___________________________________________________________29
 
Infants & Children_____________________________________________________________29
 
The Elderly__________________________________________________________________31
 
The Cognitively Impaired_______________________________________________________31
 
The Critically Ill_______________________________________________________________32
 
Culture Issues________________________________________________________________32
 
Patients with Prior History of Substance Abuse____________________________________32
 
Conclusion__________________________________________________________________33
 
Appendix A__________________________________________________________________34
 
Appendix B__________________________________________________________________35
 
References__________________________________________________________________37
 
Post Test Viewing Instructions__________________________________________________39
 
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