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Pain Management

This document outlines a pain management policy and guidelines. It states that patient self-reported pain should be the primary source of pain assessment and that treatment should aim for the patient's acceptable level of pain. It describes strategies for assessing pain in patients who cannot self-report and differentiates between acute, chronic, and cancer-related pain. The document provides an overview of multi-modal pain treatment approaches, both pharmacological and non-pharmacological. It also addresses responsible opioid prescribing practices and the roles of the acute pain service.

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nurminie
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1K views25 pages

Pain Management

This document outlines a pain management policy and guidelines. It states that patient self-reported pain should be the primary source of pain assessment and that treatment should aim for the patient's acceptable level of pain. It describes strategies for assessing pain in patients who cannot self-report and differentiates between acute, chronic, and cancer-related pain. The document provides an overview of multi-modal pain treatment approaches, both pharmacological and non-pharmacological. It also addresses responsible opioid prescribing practices and the roles of the acute pain service.

Uploaded by

nurminie
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
  • Introduction to Pain Management: An introductory overview of pain management, introducing the presenter and purpose.
  • Pain Management Policy: Explains the policy requirements for effective pain screening, assessment, and patient education.
  • Determination of Pain: Details methods for assessing pain, including self-reporting and observable indicators.
  • Understanding Pain: Provides a definition of pain from a clinical perspective and its subjective nature.
  • Acute Pain: Discusses the characteristics, duration, and observable signs of acute pain.
  • Chronic Pain: Describes chronic pain as persistent and its impact on quality of life.
  • Cancer Pain: Associates pain with cancer treatments and outlines contributing factors.
  • Pain Assessment: Guidelines for the initial assessment of pain covering location, intensity, and sensory details.
  • Pain Reassessment: Outlines the need for frequent reassessment of pain to optimize treatment.
  • Assume Pain is Present (APP): Defines the APP strategy for patients unable to self-report pain.
  • FLACC Scale: Describes the FLACC scale used for scoring pain in specific patient groups.
  • OAAS Scale: Introduces the OAAS as a means to assess sedation levels in patients.
  • Pain Management Approach: Describes a multifaceted approach to pain management tailored to individual needs.
  • Multimodal Analgesia: Explains the use of multiple therapeutic modalities to achieve effective pain control.
  • Treatment Methods: Lists non-pharmacologic and pharmacologic methods for pain treatment.
  • Acute vs. Chronic Pain Management: Compares treatment strategies for acute and chronic pain management.
  • Responsible Opioid Prescribing: Highlights the importance of careful opioid prescription to prevent misuse and abuse.
  • Acute Pain Service: Describes the services available for managing acute pain including specialized staff.
  • Patient and Family Education: Stresses the role of education for patients and family on managing pain effectively.

Pain Management

Ms. Nurminie H. Ladja

Pain Management Policy


All patients must have effective pain

management
Appropriate screening and pain assessment
Documentation
Care and treatment
Pain education

Patient self report of pain must be source of

assessment whenever possible


Patients acceptable level of pain must guide

treatment

Determination of Pain
Patient self report of pain must be

source of assessment whenever


possible
Patients acceptable level of pain must

guide treatment

If the patient is unable to self report,

assessment strategies should include


Observable behaviors (facial expressions,

body movements, crying)


physiological measures (heart rate and
blood pressure).

W hat is Pain?
An unpleasant sensory and emotional experience

associated with actual or potential tissue damage,


or described in terms of such damage.
International Association for the Study of Pain (Merskey,

1979)

Pain is always subjective.


The patients self-report of pain is the single most

reliable indicator of pain.


The clinician must accept the patients self report
of pain.

Acute Pain
Acute pain presents most often with a

clear cause, relatively brief in duration


and subsides as healing takes place.
Acute pain is often accompanied by
observable objective signs of pain
increased pulse rate
increased blood pressure
Non-verbal signs and symptoms such as

facial expressions and tense muscles.

Chronic Pain
Pain that is persistent and recurrent.
When pain persists, it serves no

useful purpose and may dramatically


decrease the quality of life and
function.
Chronic pain rarely has any
observable or behavioral signs
although persons may appear
anxious or depressed.

Cancer Pain
Pain that is associated with cancer or

cancer treatment.
May be attributed to
Tumor location
Chemotherapy
Radiation therapy
Surgical treatment

Pain Assessment
Initial Pain Assessment should

include:

Location(s)
Intensity
Sensory quality
Alleviating and aggravating factors

Any new onset of pain requires a

new comprehensive pain


assessment.

Pain Reassessm ent


Every 8 hours minimally
Following the administration of pain

medications to determine the


effectiveness of the medication
and/or need for further intervention.
IV within 15 mins of administration
PO/IM/SC within 1 hour of

administration

Assum e Pain is Present (APP)


Term used to document pain in a

patient who cannot self report pain.


Because of injuries or the nature of a
procedure the patient would be
assumed to have pain.

FLACC: (Face, Legs, Activity, Cry,


Consolability)
A behavioral scale for scoring pain in

individuals who are unable to selfreport pain.


Used for age two months to seven
years
May have use beyond this age for
the cognitively impaired patient

OAAS: Observers Assessment of Alertness


and Sedation

A tool used to assess patients level

of sedation.
May be used to guide titration of
pain medication.

Pain Management Approach


Should be interdisciplinary and

multimodal.
Care is individualized and may depend on:
Pain source and intensity
Patients age
Developmental, physical, emotional and

cognitive status
Cultural beliefs
Treatment preferences
Concurrent medical conditions

M ultim odalAnalgesia
This term describes the use of multiple

modalities that are used to provide pain


relief with various parts of the pain pathway
targeted.
Decreased dependence on single modality

agents decreases the risk of side effects.


May include
Pharmacological (opioids, NSAIDS, gabapentanoids)
Relaxation techniques (biofeedback, deep
breathing)
Regional analgesia (nerve blocks, epidural
catheters)

Treatm ents M ay Include


Non-pharmacologic
Methods
Heat/cold
Relaxation
Distraction,
Guided imagery,
Acupressure/acupunct

ure
Repositioning

Pharmacologic
Methods
NSAIDS
Anti-seizure

medications
Anti-depressants
Opioid analgesics
Local anesthetics
Neurolytics

Acute vs. Chronic Pain Management


Most often treated

with:

Acute Pain

Anti-seizure

Chronic
medications Pain

Anti-depressant

Most often treated

with:
NSAIDS
Opioids
Local anesthetics
Splinting
Positioning changes
Ice

medications
NSAIDS
Implantable devices
Psychological therapy
Acupuncture

When all else fails and

benefits outweigh
risks
Opioids

Responsible Opioid Prescribing


There is a national epidemic occurring

involving the misuse, abuse and diversion


of prescription opioids.
The majority of these medications enter
circulation through the legitimate
prescription by physicians from all
specialties.
Prescribers must be aware that their opioid
prescription could potentially end up being
used for reasons not prescribed (sold,
snorted, traded).

Responsible Opioid Prescribing


Assess risk for opioid abuse or diversion

prior to prescribing opioid.


Risk factors for misuse or abuse of opioids
include the following
Males between 18 and 45.
A personal history of substance abuse
A family history of substance abuse
A personal history of preadolescent sexual abuse
A personal history of psychological disease

(depression, anxiety, obsessive-compulsive


disorder

Responsible O pioid Prescribing


Doctor Shopping
Using more than one doctor to obtain opioids

Prevent by checking databases


External medication history on EMR
New York State Prescription Drug Monitoring

System
[Link]
/appmanager/hcs/home
1-866-529-1890 (M-F 8-4:45pm)

Acute Pain Service


Provides 7 days per week, 24 hour

consultative services every day of


the year.
Staffed by anesthesiologists, nurse
practitioners, RNs, and resident
physicians.
Manages IV PCA, epidural catheters,
nerve block catheters.
Page 4-8106 for assistance.

Acute Pain Service


The Acute Pain Service must be notified

for:
Patients who report an indwelling device for

pain management (e.g. intrathecal pain pump


or spinal cord stimulator).
Any pre-surgical patient who is followed by an
outpatient pain clinic.
Any pre-surgical patient who is receiving long
acting/controlled release narcotics (e.g.: MS
Contin, Kadian, OxyContin, Fentanyl patch,
methadone).
Any pre surgical patient who reports or tests
positive for illicit drug use.

Pain M anagem ent


Treatments offered
Comprehensive evaluations
Epidural steroid injections
Spinal injections
Nerve blocks
Psychological evaluation and treatment
Opioid risk evaluation

Patient and Family Education


All patients and family must receive

education on their right to effective


pain management which may
include:
How to report pain using the pain scales.
Importance of reporting pain as accurately and

promptly as possible.
Use of pumps and other technologies used in pain
control.
Use of non-pharmacologic and pharmacologic
methods of relieving pain.
Importance of notifying staff of unrelieved pain.
Identification of an acceptable functional pain level
that will allow them to participate in their prescribed

Patient and Family Education


Patients and family are given specific

instructions prior to discharge


regarding
Pain control
Pain medications
Management of potential side effects

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