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Book Details
Abstract
Pain Assessment and Pharmacologic Management, by highly renowned authors Chris Pasero and Margo McCaffery, is destined to become the definitive resource in pain management in adults. It provides numerous reproducible tables, boxes, and figures that can be used in clinical practice, and emphasizes the benefits of a multimodal analgesic approach throughout. In addition, Patient Medication Information forms for the most commonly used medications in each analgesic group can be copied and given to patients. This title is an excellent resource for nurses to become certified in pain management.
- Presents best practices and evidence-based guidelines for assessing and managing pain most effectively with the latest medications and drug regimens.
- Features detailed, step-by-step guidance on effective pain assessment to help nurses appropriately evaluate pain for each patient during routine assessments.
- Provides reproducible tables, boxes, and figures that can be used in clinical practice.
- Contains Patient Medication Information forms for the most commonly used medications in each analgesic group, to be copied and given to patients.
- Offers the authors' world-renowned expertise in five sections:
- Underlying Mechanisms of Pain and the Pathophysiology of Neuropathic Pain includes figures that clearly illustrate nociception and classification of pain by inferred pathology.
- Assessment includes tools to assess patients who can report their pain as well as those who are nonverbal, such as the cognitively impaired and critically ill patients. Several pain-rating scales are translated in over 20 languages.
- Nonnopioids includes indications for using acetaminophen or NSAIDs, and the prevention and treatment of adverse effects.
- Opioids includes guidelines for opioid drug selection and routes of administration, and the prevention and treatment of adverse effects.
- Adjuvant Analgesics presents different types of adjuvant analgesics for a variety of pain types, including persistent (chronic) pain, acute pain, neuropathic pain, and bone pain. Prevention and treatment of adverse effects is also covered.
- Includes helpful Appendices that provide website resources and suggestions for the use of opioid agreements and for incorporating pain documentation into the electronic medical record.
- Covers patients from young adults to frail older adults.
- Provides evidence-based, practical guidance on planning and implementing pain management in accordance with current TJC guidelines and best practices.
- Includes illustrations to clarify concepts and processes such as the mechanisms of action for pain medications.
- Features spiral binding to facilitate quick reference.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Pain Assessment and Pharmacologic Management | i | ||
| Copyright Page | ii | ||
| Dedication | iii | ||
| Contributors | v | ||
| Foreword | vii | ||
| Acknowledgements | ix | ||
| Contents | xi | ||
| References | 11 | ||
| Chapter 1: Underlying Complexities of Pain Assessment | 15 | ||
| Failure to Assess Pain and Underestimation of Pain | 15 | ||
| Failure to Accept Patient’s Reports of Pain | 17 | ||
| Failure to Act on Patient’s Reports of Pain | 19 | ||
| Conclusion | 19 | ||
| Chapter 2: Misconceptions that Hamper Assessment and Treatment of Patients Who Report Pain | 20 | ||
| Subjectivity of Pain | 20 | ||
| Pain Threshold: Uniform versus Variable | 24 | ||
| Pain Tolerance: High versus Low | 24 | ||
| Behavioral and Physiologic Responses to Pain | 25 | ||
| Causes of Pain | 29 | ||
| Addiction | 32 | ||
| Pain Relief from Placebos | 42 | ||
| Other Hidden Biases and Misconceptions | 45 | ||
| Conclusion | 47 | ||
| Chapter 3: Assessment Tools | 49 | ||
| Tools for Initial Pain Assessment | 49 | ||
| Reassessment | 102 | ||
| Communication Strategies | 119 | ||
| Conclusion | 142 | ||
| Chapter 4: Other Challenges in Pain Assessment | 143 | ||
| Patients Who are Critically Ill | 143 | ||
| Patients Who are Unconscious | 147 | ||
| Patients Who are Intellectually Disabled | 148 | ||
| Patients Who are Mentally Ill | 153 | ||
| Cultural Considerations | 159 | ||
| Chapter 5: Indications for Administration of Acetaminophen or NSAIDs | 181 | ||
| Acute Pain | 183 | ||
| Persistent (Chronic) Pain | 183 | ||
| Nonopioid Plus Opioid | 184 | ||
| Conclusion | 184 | ||
| Chapter 6: Adverse Effects of Acetaminophen and NSAIDs | 185 | ||
| Adverse Effects of Acetaminophen | 185 | ||
| Adverse Effects of NSAIDs | 190 | ||
| Hypersensitivity to Nonopioids: Respiratory and Cutaneous Reactions | 207 | ||
| Conclusion | 208 | ||
| Chapter 7: Individualizing the Selection of Nonopioid Analgesics | 209 | ||
| General Considerations | 209 | ||
| Choice of Starting Dose and Dose Titration | 217 | ||
| Special Circumstances and Conditions | 220 | ||
| Conclusion | 226 | ||
| Chapter 8: Perioperative Nonopioid Use | 227 | ||
| Effectiveness | 227 | ||
| Perioperative Multimodal Analgesia | 228 | ||
| Preemptive Analgesia | 228 | ||
| Accelerated Multimodal Postoperative Rehabilitation | 229 | ||
| Adverse Effects | 233 | ||
| Conclusion | 238 | ||
| Chapter 9: Nonprescription Nonopioids | 239 | ||
| Buffered Aspirin | 239 | ||
| Caffeine | 239 | ||
| Antihistamines | 240 | ||
| Conclusion | 245 | ||
| Chapter 10: Acute Overdose | 247 | ||
| Acetaminophen | 247 | ||
| Aspirin and Other Salicylates | 247 | ||
| Other NSAIDs | 248 | ||
| Conclusion | 248 | ||
| References | 260 | ||
| Chapter 11: Physiology and Pharmacology of Opioid Analgesics | 283 | ||
| Groups of Opioids | 283 | ||
| Underlying Mechanisms of Opioid Analgesia and Adverse Effects | 283 | ||
| Pharmacologic Concepts | 286 | ||
| Conclusion | 300 | ||
| Chapter 12: Key Concepts in Analgesic Therapy | 301 | ||
| Multimodal Analgesia | 301 | ||
| WHO Analgesic Ladder for Cancer Pain Relief | 301 | ||
| Preemptive Analgesia for Postoperative Pain Management | 305 | ||
| Accelerated Multimodal Postoperative Rehabilitation | 306 | ||
| Around-the-Clock (ATC) Dosing | 308 | ||
| PRN Dosing | 312 | ||
| Patient-Controlled Analgesia (PCA) | 313 | ||
| Conclusion | 322 | ||
| Chapter 13: Guidelines for Opioid Drug Selection | 323 | ||
| Other Mu Opioid Analgesics | 353 | ||
| Characteristics of Selected Agonist-Antagonist Opioids | 356 | ||
| Dual Mechanism Analgesics | 360 | ||
| Effects of Patient Characteristics on Opioid Drug Selection | 362 | ||
| Conclusion | 367 | ||
| Chapter 14: Guidelines for Selection of Routes of Opioid Administration | 368 | ||
| Oral | 368 | ||
| Oral Transmucosal | 378 | ||
| Nebulized | 386 | ||
| Rectal | 387 | ||
| Transdermal | 390 | ||
| Parenteral | 396 | ||
| Conclusion | 401 | ||
| Chapter 15: Intraspinal Analgesia (Epidural and Intrathecal) | 404 | ||
| Spinal Anatomy | 404 | ||
| Delivery of Intraspinal Analgesics | 408 | ||
| Selected Analgesics Administered by the Intraspinal Routes | 417 | ||
| Complications Associated with the Intraspinal Routes of Administration | 430 | ||
| Tapering and Cessation of Epidural Analgesia | 440 | ||
| Conclusion | 440 | ||
| Chapter 16: Initiating Opioid Therapy | 442 | ||
| Selecting an Analgesic and Route of Administration | 442 | ||
| Selecting an Opioid Dose | 443 | ||
| Chapter 17: Intravenous Patient-Controlled Analgesia | 462 | ||
| Initial Intravenous Patient-Controlled Analgesia (PCA)Prescription | 462 | ||
| Authorized Agent-Controlled Analgesia | 470 | ||
| Operator Errors: Misprogramming Analgesic Infusion Pumps | 471 | ||
| Infusion Solution and Tubing Changes | 471 | ||
| Tapering and Cessation of Parenteral Analgesia | 471 | ||
| Conclusion | 472 | ||
| Chapter 18: Switching to Another Opioid or Route of Administration | 473 | ||
| Chapter 19: Management of Opioid-Induced Adverse Effects | 483 | ||
| Constipation | 484 | ||
| Postoperative Ileus | 491 | ||
| Nausea and Vomiting in Patients Receiving Long-Term Opioid Therapy | 492 | ||
| Biliary Spasm | 498 | ||
| Pruritus | 499 | ||
| Hypotension | 501 | ||
| Urinary Retention | 502 | ||
| Myoclonus | 502 | ||
| Mental Status Changes | 503 | ||
| Sedation During Short-Term Opioid Therapy in Opioid-Naïve Patients | 509 | ||
| Conclusion | 522 | ||
| Chapter 20: Unwarranted Withholding of Opioids | 523 | ||
| Long-Term Opioid Use in Patients with Persistent Noncancer Pain | 523 | ||
| Withholding Opioids from Patients with Addictive Disease | 527 | ||
| Opioid Use During Pregnancy | 530 | ||
| Opioid Use During Breast-Feeding | 533 | ||
| Opioid Use in the Critically Ill | 533 | ||
| Managing Pain in the Terminally Ill | 535 | ||
| References | 580 | ||
| Chapter 21: General Considerations in the Use of Adjuvant Analgesics | 631 | ||
| Drug Selection | 631 | ||
| Dosing | 632 | ||
| Variability in Response | 632 | ||
| Patient Co-Morbidities | 632 | ||
| Adjuvant Analgesics During Pregnancy and Breast-Feeding | 632 | ||
| Multimodal Therapy | 633 | ||
| Polypharmacy | 633 | ||
| Positioning of Treatment | 634 | ||
| Conclusion | 635 | ||
| Chapter 22: Multipurpose Adjuvant Analgesics | 636 | ||
| Antidepressant Drugs | 636 | ||
| Corticosteroids | 645 | ||
| Alpha2-Adrenergic Agonists | 648 | ||
| Conclusion | 652 | ||
| Chapter 23: Adjuvant Analgesics for Persistent (Chronic) Neuropathic Pain | 653 | ||
| Anticonvulsant Drugs | 653 | ||
| Sodium Channel Blockers | 666 | ||
| Gamma Aminobutyric Acid (GABA) Agonists | 672 | ||
| N-Methyl-d-Aspartate (NMDA) Receptor Antagonists | 674 | ||
| Ziconotide | 680 | ||
| Conclusion | 683 | ||
| Chapter 24: Topical Analgesics for Persistent (Chronic) Pain | 684 | ||
| Lidocaine Patch 5% | 684 | ||
| Emla | 688 | ||
| Other Local Anesthetics | 689 | ||
| Capsaicin | 689 | ||
| Antidepressants | 691 | ||
| Anticonvulsants | 691 | ||
| Clonidine | 691 | ||
| Ketamine | 692 | ||
| Summary of Indications for Topical Analgesics for Persistent Pain | 692 | ||
| Summary of Adverse Effects of Topical Analgesics for Persistent Pain | 692 | ||
| Conclusion | 692 | ||
| Chapter 25: Adjuvant Analgesics for Musculoskeletal Pain | 693 | ||
| Skeletal Muscle Relaxants | 693 | ||
| Benzodiazepines | 695 | ||
| Conclusion | 695 | ||
| Chapter 26: Adjuvant Analgesics for Postoperative and Other Acute Pain | 696 | ||
| Continuous Peripheral Nerve Block | 696 | ||
| Continuous Local Anesthetic Wound Infusion | 704 | ||
| IV Lidocaine | 705 | ||
| Clonidine | 710 | ||
| Corticosteroids | 712 | ||
| N-Methyl-d-Aspartate (NMDA) Receptor Antagonists | 713 | ||
| Conclusion | 717 | ||
| Chapter 27: Adjuvant Agents for Goal-Directed Sedation in the Critically Ill and for Procedural Sedation | 718 | ||
| Propofol | 718 | ||
| Fospropofol | 722 | ||
| Dexmedetomidine | 722 | ||
| Benzodiazepines | 724 | ||
| Ketamine | 725 | ||
| Conclusion | 725 | ||
| Chapter 28: Local Anesthetics for Procedural Pain | 726 | ||
| Infiltrated Lidocaine | 726 | ||
| L.M.X.4 | 729 | ||
| Synera | 729 | ||
| Jet Injection | 729 | ||
| LET, TLC, and TAC | 730 | ||
| Other Local Anesthetic Approaches for Procedural Pain | 730 | ||
| Conclusion | 732 | ||
| Chapter 29: Adjuvant Analgesics for Persistent (Chronic) Bone Pain | 733 | ||
| Calcitonin | 733 | ||
| Bisphosphonates | 734 | ||
| Radiopharmaceuticals | 735 | ||
| Conclusion | 736 | ||
| Chapter 30: Adjuvant Analgesics for Malignant Bowel Obstruction | 737 | ||
| Anticholinergic Drugs | 738 | ||
| Corticosteroids | 740 | ||
| Conclusion | 740 | ||
| Chapter 31: Adjuvants Less Often Used | 741 | ||
| Psychostimulants and Anticholinesterases | 741 | ||
| Calcitonin | 742 | ||
| Neuroleptics | 743 | ||
| Benzodiazepines | 743 | ||
| Vitamin D | 745 | ||
| Nicotine | 745 | ||
| Alcohol (Ethanol) | 746 | ||
| Conclusion | 746 | ||
| References | 783 | ||
| Appendix A: Pain Resources on the Internet | 819 | ||
| Introduction and History | 819 | ||
| Information about the Internet | 819 | ||
| Access to the Internet | 819 | ||
| Selected Features of the Internet | 820 | ||
| Looking for Health Information on the Internet | 822 | ||
| Quality of Health Information on the Internet | 822 | ||
| References | 826 | ||
| Appendix B: Clinical Aspects of the Use of Opioid Agreements for Chronic Noncancer Pain | 827 | ||
| Clarifying Agreements versus Contracts | 827 | ||
| The Philosophy Behind the Agreement: Education/Motivating versus Infantilizing | 832 | ||
| Universality and How the OA Is Given to the Patient | 832 | ||
| Flexible Language | 832 | ||
| Limit Setting | 833 | ||
| Correlates to Urine Drug Screening | 834 | ||
| Conclusion | 835 | ||
| References | 835 | ||
| Appendix C: Use of Electronic Medical Records in Pain Management | 837 | ||
| Pain-Related Electronic Medical Record Components | 839 | ||
| The University of Maryland Medical Center Experience | 851 | ||
| Safeguards | 855 | ||
| Conclusion | 855 | ||
| References | 856 | ||
| Appendix D: Terminology | 858 | ||
| Terminology Related to Research | 861 | ||
| Index | 863 |