Nurses at Ann and Robert H. Lurie Children’s Hospital of Chicago manage baby boy’s postoperative pain following heart transplant. Photo courtesy of Ann and Robert H. Lurie Children’s Hospital.

In my experience working with severely ill or injured patients, pain was what they talked about the most. They either asked about it prior to a treatment or intervention (“How much is this going to hurt?”), relived their history with it (“This pain isn’t as bad as the pain I had….”), or were consumed with fear that it would never end (“I can’t handle this—can’t they give me anything for it?”).

Post-op patients mostly had the same standard order, whether they were slightly built women or burly men: meperidine 25mg q3-4 h IM. I remember watching the time so I could administer the medication as soon as the clock would allow—and sometimes “fudging” the time a bit because the medication wasn’t “holding” the patient. It was one of the topmost issues for nurses in acute care—how to ensure patients were comfortable and pain free. As a nurse, not being able to provide pain relief for a patient left you feeling like a failure.

The evolving science of pain management.

Well, times have changed, and we’ve learned more about pain pathways and better ways of combining various modalities—nonpharmacologic interventions as well as new medications and new uses of older drugs, patient-controlled analgesia pumps, and multimodal therapy (see our special report, Multimodal Analgesia for Acute Pain: An Evidence-Based Approach) to treat acute pain.

Longer-term consequences of inadequate post-op pain relief.

We also now know that adequately managing pain in the acute period is critical to forestall later complications. As the authors of one of this month’s CE articles, “Managing Postoperative Pain,” note, “Inadequately relieved postoperative pain may be a risk factor for persistent postoperative pain, chronic pain, and disability.”

The authors acknowledge that, while opioid abuse in America is indeed at an all-time high and warrants careful attention to proper prescribing practices, research indicates that acute postoperative pain often remains undertreated.

The latest guidelines and evidence.

This article reviews updated American Pain Society guidelines and recommendations on the management of postoperative pain. The Joint Commission has also released new standards that focus on evidence-based care, effective as of January 1, 2018. As the authors of this CE article note:

“Nurses must be able to distinguish clinical practices supported by strong evidence from those with insufficient or weak evidence, as well as evidence-based recommendations from expert opinion.”

A short, informative video .

This article will help you do that, and also provides historical context around the challenging issue of pain treatment. And to get a real feel for the issues covered in this article, watch a short video with lead author Renee Manworren.