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Pain Assessment and Pharmacologic Management - E-Book

Pain Assessment and Pharmacologic Management - E-Book

Chris Pasero | Margo McCaffery



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:
    1. Underlying Mechanisms of Pain and the Pathophysiology of Neuropathic Pain includes figures that clearly illustrate nociception and classification of pain by inferred pathology.
    2. 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.
    3. Nonnopioids includes indications for using acetaminophen or NSAIDs, and the prevention and treatment of adverse effects.
    4. Opioids includes guidelines for opioid drug selection and routes of administration, and the prevention and treatment of adverse effects.
      1. 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.
    5. 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.
    6. Covers patients from young adults to frail older adults.
    7. Provides evidence-based, practical guidance on planning and implementing pain management in accordance with current TJC guidelines and best practices.
    8. Includes illustrations to clarify concepts and processes such as the mechanisms of action for pain medications.
    9. 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