Evidence-Based Practice: Managing Acute Pain

Across the hospital, acute pain is a major health concern, and you and your colleagues face the challenge of managing your patients’ highly individualized experiences of pain. You know that patients have a right to appropriate pain assessment and management. You also recognize that poorly controlled pain can slow patient recovery, reduce the sense of well-being, and distress family members and friends.

Yet certain barriers can affect the best outcome for pain management because of a patient’s fear of opioids and addiction, fear that analgesic overuse may delay recovery, and beliefs about pain and suffering. To overcome these barriers and relieve pain effectively and consistently, follow these evidence-based practices:

• Routinely assess for the presence of pain, and the patient’s response to the treatment plan. Remember, pain is what the patient says it is.
• Consistently use a validated pain scale, such as a numeric or visual analog scale.
• Systematically assess for physiologic signs and symptoms of pain.
• Identify cultural factors that may affect the patient’s pain perception.
• Observe for signs and symptoms of physical dependence on pain medication.

• Teach the patient and family members about reporting pain, and develop an intervention plan with them.
• Administer nonopioid drugs as prescribed, even during opioid therapy.
• Treat constant pain by giving pain medications around-the-clock as prescribed and administering breakthrough medications as needed.
• Administer aspirin for moderate to severe pain, and use acetaminophen for postoperative pain, as prescribed unless contraindicated
• Follow patient-controlled analgesia (PCA) protocols for postoperative pain.
• Use the oral route whenever possible. For parenteral administration, the intravenous or subcutaneous route is preferred. Question orders for intramuscular medication, particularly for meperidine.
• Recognize and treat adverse effects of pain medications. For example, start a regimen to prevent constipation during opioid therapy.
• Use nonpharmacologic interventions, such as relaxation techniques, distraction, massage, guided imagery, and art or music therapy.

• Reassess the patient after providing pain-relief measures and evaluate their effectiveness of pain measure.
• Observe for a decrease in or elimination of signs and symptoms of pain.
• Revise the pain-management plan if pain is not controlled.

For research details and additional information, check out Evidence-Based Nursing Monographs: Acute Pain in Mosby’s NursingConsult.

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