Multimodal analgesia important for effective control of pain

Sep 20 2011

Efforts to effectively control pain in hospitalized patients with opioid (narcotic) analgesics can lead to unintentional sedation and respiratory depression, which are serious adverse events affecting the quality of recovery for patients. These unintended consequences may be avoided with individualized patient care plans, safe administration of these drugs, and appropriate monitoring practices, report Penn Nursing pain expert Rosemary C. Polomano, PhD, RN, and her colleagues on a panel appointed by the American Society for Pain Management Nursing (ASPMN).

Opioid analgesics, the standard of care for managing pain in hospitalized patients, are increasingly successful in reducing pain. At the same time, the common and effective practice of using combinations of multiple analgesics that target different causes of pain, referred to as multimodal analgesia, calls for more aggressive approaches to assessment and monitoring, the ASPMN panel stated in the September issue of "Pain Management Nursing."

The ASPMN panel conducted a review of current research and guidelines for opioid analgesics and a nationwide survey to examine current monitoring practices by nurses. The panel developed recommendations, many of them centered on nursing practice and leadership to promote safer and improved pain control with a greater likelihood of decreasing episodes of serious opioid-induced adverse events.

"Multimodal analgesia is extremely important to the effective control of pain," says Dr. Polomano, senior author and ASPMN panelist Rosemary C. Polomano, PhD, RN, associate professor at the University of Pennsylvania School of Nursing. "Nurses have important roles in understanding this therapy. They are in the best position to detect changes in patient status. Nurses need to be knowledgeable about the pharmacological properties of analgesics to maximize pain control, and be more proactive in monitoring patients, especially those at high risk for adverse events."

The ASPMN panel emphasized that nurses are critical to identifying patients at risk for unintended over-sedation and respiratory depression, two of the most serious adverse effects of opioid analgesic therapy. The panel advocates individualized patient assessments for risk; ongoing monitoring of sedation levels and respiratory status; and technology-supported monitoring for high-risk patients. At the hospital level, the panel recommended specific educational content for nurses on analgesics and practices to reduce adverse events from opioids such as over-sedation and respiratory depression. The panel also recommended hospital-wide policies and procedures along with quality improvement and surveillance programs specific to pain management to ensure safer, optimal pain care.

The recommendations, the panel notes, are intended to reflect "the uniqueness of patients, autonomy in nurses' judgments and decision-making, and foundations of professional nursing practice."

Source American Society for Pain Management Nursing