Documentation : Pain Reassessment

Documentation

  • Documentation is critical to ensure effective communication pain assessment tools
  • Multidimensional pain assessment tools

Pain Reassessment

  • Critical to reassess at appropriate intervals, guided by
    • Pain severity
    • Physical and psychosocial condition
    • Type of intervention
    • Risks of adverse effects
    • Institutional policy

Drug Therapy

  • 3 categories of medications
    • Non-opioid
      • acetaminophen, aspirin and other salicylates, and NSAIDs
    • Opioid
      • Produce their effects by binding to receptors in the CNS categorized according to their physiologic action (i.e., agonist, antagonist) and binding at specific opioid receptors (e.g., mu, kappa, delta).
    • Adjuvant
      • Analgesic adjuvants are drugs that can be used alone or in conjunction with opioid and non-opioid analgesics. 
      • Generally, these agents were developed for other purposes (e.g., anti-seizure drugs, antidepressants) and found to be effective for treating pain.

Administration

  • Scheduling
    • Focus on prevention or control
    • Do not wait for severe pain
    • Constant pain requires around-the-clock administration (not PRN)
    • Fast-acting drugs for breakthrough
  • Titration
    • Dose adjustment based on assessment of analgesic effect versus side effects
    • Use the smallest dose to provide effective pain control with fewest side effects
  • Administration Routes
    • Oral
      • Route of choice with functioning GI system
      • Doses are larger due to first pass effect
    • Trans-mucosal and buccal route
      • Fentanyl lozenge on a stick
      • Cannabinoid extract spray
    • Intranasal route
      • Delivery to vascular mucosa, avoiding first-pass effect
    • Rectal
      • Useful in the case of severe nausea or vomiting
    • Transdermal route
    • Parenteral routes
      • IM (Intramuscular), SQ (Subcutaneous), and IV (Intravenous) 
    • Intra-spinal delivery
      • Highly potent (smaller doses necessary)
    • Implantable pumps
    • Patient-controlled analgesia (PCA)
      • A dose of opioid is delivered when the patient decides a dose is needed
      • Patient pushes a button to deliver a bolus dose of opioid IV
      • Teach patient that they cannot “overdose”
    • Intra-spinal delivery
      • Epidural space (epidural)
      • Subarachnoid space (intrathecal)
      • Intermittent bolus or continuous infusion
      • Delivered close to receptors in the dorsal horn