Some of the most difficult times I experienced as a nurse involved patients in pain. This was before the days of patient-controlled analgesia, when patients in acute pain were mostly managed with “Demerol IM q4h.”
I recall many incidents of paging and telephoning and beeping physicians and residents to get orders for pain medications and trying whatever non-pharma methods I could think of to allay pain. It was awful to see patients suffer needlessly.
Progress, But with a Cost
Then pain became a key part of assessment, as well as of patient satisfaction scoring, and clinicians heeded the need for managing pain. However, there has been too much reliance on the quick fix of strong opioids. A friend who recently had surgery was asked by a nurse to rate his pain. When he replied “eight,” she asked him if he wanted one or two oxycodone pills. His reply, “Well, what do people usually take?”
Revising the Approach to Pain Management
Thankfully, pain management is being revisited, and along with a renewed focus on not prescribing by the numbers (a patient’s pain rating should only be one factor in deciding the intervention), there is a greater understanding of pain and how it can become chronic, and there are more modalities at our disposal to manage it.
To prevent acute pain from transforming into chronic pain, it needs to be managed effectively from the beginning—and that means having a plan that targets complex pain mechanisms.
Last month, we published a peer-reviewed supplement, “Multimodal Analgesia for Acute Pain: An Evidence-Based Approach.” The guest editors of this special report, Rosemary C. Polomano, PhD, RN, FAAN, and Carla R. Jungquist, PhD, RN, ANP-BC, FAAN, provide a comprehensive update on pain, including a review of pain physiology and mechanisms, multimodal interventions, and recommendations based on guidelines and expert consensus reports. Supported by an unrestricted educational grant from Mallinckrodt Pharmaceuticals, it’s available without charge.