Abstract
The foundation of safe and effective pain management is an individualized, comprehensive
pain assessment that includes, but is not limited to, the intensity of pain if the
patient is able to report it. An unforeseen consequence of the widespread use of pain
intensity rating scales is the practice of prescribing specific doses of opioid analgesics
based solely on specific pain intensity ratings. Many factors in addition to pain
intensity influence opioid requirements. To date there is no research demonstrating
that a specific opioid dose will relieve pain of a specific intensity in all patients
or even in the same patient at different times. The official position of the American
Society for Pain Management Nursing (ASPMN) maintains that the practice of prescribing
doses of opioid analgesics based solely on pain intensity should be prohibited because
it disregards the relevance of other essential elements of assessment and may contribute
to untoward patient outcomes.
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References
American Society for Pain Management Nursing and American Nurses Association. (2016). Pain management nursing scope and standards of practice. Silver Springs, MD: American Nurses Association.
American Society for Pain Management Nursing® (ASPMN®) Task Force on Dosing to Numbers. (2015). Scope of Registered Nurse Practice Related to Opioid Dose Range Orders. Query to all State Boards of Nursing in the United States. Unpublished data.
- Autonomy and morality: A Self-Determination Theory discussion of ethics.New Ideas in Psychology. 2017; 47: 57-61
- History of The Joint Commission pain standards: Lessons for today's prescription opioid epidemic.Journal of the American Medical Association. 2017; 317: 1117-1118
- Essential elements of multimodal analgesia in Enhanced Recovery after Surgery (ERAS) guidelines.Anesthesiology Clinics. 2017; 35: e115-e143
- Evaluation of a pain management education program and operational guideline on nursing practice, attitudes, and pain management.Journal of Continuing Education in Nursing. 2018; 49: 178-185
- Cut-off points for mild, moderate, and severe pain on the numeric rating scale for pain in patients with chronic musculoskeletal pain: variability and influence of sex and catastrophizing.Frontiers in Psychology. 2016; 7: 1466
- Nurses’ knowledge and attitudes about pain: Personal and professional characteristics and patient reported pain satisfaction.Pain Management Nursing. 2017; 18: 214-223
- American Pain Society (APS) 1995 Presidential address.Pain Forum. 1996; 5: 85-88
- Management of postoperative pain: A clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council.Journal of Pain. 2016; 17: 131-157
- Pain assessment in cognitively intact adults.Assessment and multimodal management of pain: An integrative approach. A. Elsevier, St. Louis2021: 73-119
- Basic concepts involved with administration of analgesic medications.in: Cooney M.F. Quinlan-Colwell A. Assessment and multimodal management of pain: An integrative approach. Elsevier, St. Louis, MO2020: 163-194
- Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep deprivation in adult patients in the ICU.Critical Care Medicine. 2018; 46: e825-e873
- CDC guideline for prescribing opioids for chronic pain—United States, 2016.MMWR Recommendations and Reports. 2016; 65 (No. RR-1)Retrieved August 24, 5051, from: 1-49
- As-Needed” Range orders for opioid analgesics in the management of pain: A consensus statement of the American Society for Pain Management Nursing and the American Pain Society.Pain Management Nursing. 2018; 19: 207-210
- Pain assessment.in: Czarnecki M.L. Turner H.N. Core Curriculum for Pain Management Nursing. 3rd ed. Elsevier, St. Louis, MO2018: 67-82
- Pain assessment of patients who cannot self-report pain.in: Cooney M.F. Quinlan-Colwell A. Assessment and multimodal management of pain: An integrative approach. Elsevier, St. Louis, MO2020: 120-135
- Opioid prescribing is a surrogate for inadequate pain management resources.Canadian Family Physician. 2016; 62: 465-468
- UC-Davis train-the-trainer primary care pain management fellowship: Addressing the pain management education gap.Academic Medicine. 2021; 96: 236-240
- Addressing the public health crisis of excessive opioid prescribing and inadequate pain management through closing the pain education gap.Pain Medicine. 2020; 22: 9-13
- Research gaps in practice guidelines for acute postoperative pain management in adults: findings from a review of the evidence for an American Pain Society Clinical Practice Guideline.Journal of Pain. 2016; 17: 158-166
- Clinical practice guidelines for pain management in acute musculoskeletal injury.Journal of Orthopedic Trauma. 2019; 33: e158-e182
Institute for Safe Medication Practices (ISMP). (2015, August). Draft guidelines for the safe communication of electronic medication information. www.ismp.org/tools/guidelines/SCEMI/
- What determines whether a pain is rated as mild, moderate, or severe? The importance of pain beliefs and pain interference.Clinical Journal of Pain. 2017; 33: 414-421
- Bioethics: A nursing perspective.Elsevier Health Sciences, Chatswood, New South Wales2019
- Preventing opioid-induced advancing sedation and respiratory depression.in: Cooney M.F. Quinlan-Colwell A. Assessment and multimodal management of pain: An integrative approach. Elsevier, St. Louis, MO2020: 337-359
- Ethics of opioid prescriber regulations: Physicians, patients, and pain.Journal of Bone and Joint Surgery. 2019; 101: e128
- Pain as the fifth vital sign” and dependence on the “numerical pain scale” is being abandoned in the US: why?.British Journal of Anaesthesia. 2018; 120: 435-438
- When order sets do not align with clinician workflow: assessing practice patterns in the electronic health record.BMJ Quality & Safety. 2019; 28: 987-996
- Brain mechanisms of social touch-induced analgesia in females.Pain. 2019; 160: 2072-2085
- Nursing practice theories related to cognition, bodily pain, and man-environment interactions. University of California at Los Angeles Students’ Store, Los Angeles, CA1968: 1-10
- Pain as the fifth vital sign: Exposing the vital need for pain education.Clinical Therapeutics. 2013; 35: 1728-1732
- Healthy north carolina 2030: A path toward health.2020
- Opioid-prescribing guidelines for common surgical procedures: an expert panel consensus.Journal of the American College of Surgeons. 2018; 227: 411-418
- In-hospital opioid consumption, but not pain intensity scores, predicts 6-month levels of pain catastrophizing following hepatic resection: A trajectory analysis.European Journal of Pain. 2019; 23: 503-514
- American Society for Pain Management Nursing position statement: prescribing and administering opioid doses based solely on pain intensity.Pain Management Nursing. 2016; 17: 170-180
- The influence of race, ethnicity and genetic variants on post-operative pain intensity: An integrative literature review.Pain Management Nursing. 2019; 20: 198-206
- Legal and ethical issues for health professionals.5th ed. Jones & Bartlett Learning, Burlington, VT2020
- Design and implementation of an analgesia, sedation, and paralysis order set to enhance compliance of pro re nata mediation orders with Joint Commission medication management standards in a pediatric ICU.Joint Commission Journal on Quality and Patient Safety. 2020; 46: 706-714
- Promoting evidence-based practice and dispelling urban legends to achieve safer pain management.Journal of Perianesthesia Nursing. 2018; 33: 96-100
- Importance of multimodal pain management.in: Cooney M.F. Quinlan-Colwell A. Assessment and multimodal management of pain: An integrative approach. Elsevier, St. Louis, MO2020: 19-27
- Assessing the Impact of the Position Paper “Prescribing and Administering Opioid Doses Based Solely on Pain Intensity.Pain Management Nursing. 2018; 19: 573-579
- Common Unintended Effects of Opioids.in: Cooney M.F. Quinlan-Colwell A. Assessment and multimodal management of pain: An integrative approach. Elsevier, St. Louis, MO2020: 303-336
- Improving institutional commitment for effective multimodal pain management.in: Cooney M.F. Quinlan-Colwell A. Assessment and multimodal management of pain: An integrative approach. Elsevier, St. Louis, MO2020: 770-796
- The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises.Pain. 2020; 161: 1976-1982
- Pain management.in: Craven R. Hirnle C. Henshaw C. Fundamentals of nursing: Health and human function. 9th ed. Wolters Kluwer, New York, NY2020
- Reported pain and fatigue behaviors mediate the relationship between catastrophizing and perceptions of solicitousness in patients with chronic fatigue.Journal of Pain. 2016; 17: 328-335
- Sleep and pain sensitivity in adults.Pain. 2015; 156: 1433-1439
- Pain intensity as a lagging indicator of patient improvement: Longitudinal relationships with sleep, psychiatric distress, and function in multidisciplinary care.Journal of Pain. 2021; 22: 313-321
- Opioid medication use in the surgical patient: An assessment of prescribing patterns and use.Journal of the American College of Surgeons. 2018; 227: 203-211
- Non-pharmacologic and non-opioid solutions for pain management.Quick Safety. 2018; 44 (August 2018. Retrieved August 24, 2021, from)
- Pain assessment and management standards for hospitals.R3 Report: Requirement, Rationale, Reference. 2017; (August 29, 2017. Retrieved March 19, 2021, from)
- A debate on the proposition that self-report is the gold standard in assessment of pediatric pain intensity.Clinical Journal of Pain. 2015; 31: 707-712
- Moving beyond pain scores: Multidimensional pain assessment is essential for adequate pain management after surgery.PLoS One. 2017; 12e0177345
- Pain: The 5th vital sign.Department of Veterans Affairs, Washington DC2000
- What nurses' work-arounds tell us about pain assessment.International Journal of Nursing Studies. 2016; 67: A1-A2
- Recent advances in acute pain management: Understanding the mechanisms of acute pain, the prescription of opioids, and the role of multimodal pain therapy.F1000Research. 2017; 6: 2065
Washington State Agency Medical Directors and Robert Bree Collaborative, Prescribing Opioids for Post operative Pain – supplemental guidance. 2017. Retrieved 4/24/2021 http://www.agencymeddirectors.wa.gov/Files/FinalSupBreeAMDGPostopPain091318wcover.pdf
- Interagency guideline on prescribing opioids for pain.3rd ed. 2015 (Retrieved August 15, 2021, from)
- Optimizing numeric pain rating scale administration for children: The effects of verbal anchor phrases.Canadian Journal of Pain. 2017; 1: 191-198
Article info
Publication history
Published online: December 19, 2021
Accepted:
November 13,
2021
Received:
October 15,
2021
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of American Society for Pain Management Nursing.
