KNOWLEDGE:
Know the International Association for the Study of Pain (IASP) definition of pain.
Describe 3 ways to assess pain.
Know
the maximum recommended daily doses of acetaminophen and aspirin
State
the 7 necessary components of
writing a PCA order.
Know
why meperidine is NOT the opioid of choice for chronic pain management.
Describe
the common side effects of opioids.
Describe
the uncommon side effects of opioids.
Describe
abstinence syndrome.
Know that 10 mg MSO4 IV/IM is the gold standard for comparison
of opioid equivalency in regards to analgesia.
SKILLS:
Be
able to convert from parental opioids to oral opioids to transdermal opioids
by using 10 mg MSO4 IV/IM as the gold standard while utilizing the
equianalgesic chart.
Take
a complete pain assessment including the chief complaint which includes
location, duration, intensity, quality, associated symptoms, aggrevating and
relieving factors, and the HPI.
Incorporate VAS (visual analog scale) as part of routine vital signs
when documenting notes, and when presenting to your intern, resident,
fellow, and/or attending physician
Be able to write MSO4, hydromorphone, fentanyl PCA orders.
Write
out the IASP’s definition of pain.
Describe
the common side-effects of opioids, and their treatment.
Instruct
patients in the importance of communicating about their pain using the VAS
scale, where 0= no pain and 10= worst possible pain.
Write
out the definition of addiction.
ATTITUDES:
Understand
the psychosocial components of acute and chronic pain, and it’s potential
impact on family dynamics.
Understand
and respect cultural and spiritual differences and how this may impact
history taking, physical exam, and response to treatment.
Recognize
how personal biases and judgments may limit appropriate assessment and
treatment of pain. Develop
strategies to avoid this .
Pain
management should be considered a priority.
Accept
scheduled dosing of opioids as the norm.
Don’t
confuse opioid tolerance and physiologic dependence as addiction.
Identify potential barriers to effective pain management.
REFERENCES:
Latta
KS, Ginsberg B, Barkin LB: Meperidine:
A Critical Review, American Journal of Therapeutics 9, 53-68, 2002.
The Management of Persistent Pain in Older Persons, American Geriatric Society (AGS) Panel on Persistent Pain in Older Persons, JAGS, 50: S205-S224, 2002.
Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain, 4th Edition.
Guideline
for the Management of Acute and Chronic Pain in Sickle Cell Disease, Pages
9-32.