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Guidelines for Clinical Practice: From Development to Use
be asked their current pain intensity, the worst pain intensity in the past 24 hours, the degree of relief obtained from pain management interventions, satisfaction with relief, and their satisfaction with the staff's responsiveness.
Analgesic drug treatment should comply with several basic principles:
Non-opioid "peripherally acting" analgesics. Unless contraindicated, every patient should receive an around-the-clock postoperative regimen of an NSAID. For patients unable to take medications by mouth, it may be necessary to use the parenteral or rectal route.
Opioid analgesics. Analgesic orders should allow for the great variation in individual opioid requirements, including a regularly scheduled dose and "rescue" doses for instances in which the usual regimen is insufficient.
Specialized analgesic technologies, including systemic or intraspinal, continuous or intermittent opioid administration or patient controlled dosing, local anesthetic infusion, and inhalational analgesia (e.g., nitrous oxide) should be governed by policies and standard procedures that define the acceptable level of patient monitoring and appropriate roles and limits of practice for all groups of health care providers involved. The policy should include definitions of physician and nurse accountability, physician and nurse responsibility to the patient, and the role of pharmacy.
Nonpharmacological interventions: Cognitive and behaviorally based interventions include a number of methods to help patients understand more about their pain and to take an active part in its assessment and control. These interventions are intended to supplement, not replace, pharmacological interventions. Staff should give patients information about these interventions and support patients in using them.
Monitor the efficacy of pain treatment: Periodically review pain treatment procedures as defined in summary recommendations 1-4 above, using the institution's quality assurance procedures.