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Considering opioid-sparing approaches is a hot topic for helping patients manage their pain safely.
As nurses, you’re often in the middle of this discussion. You play an active role in understanding each patient’s unique needs and concerns at various levels of pain from different etiologies.
A multimodal pain management plan is a personalized approach to pain management that includes multiple medications and techniques, including opioid, non-opioid (prescription or over-the-counter pain relievers), and topical medications, as well as nonpharmacologic therapies.
When you incorporate a multimodal pain management plan into your nursing practice, you can have more engaging conversations with your patients and involve them directly in their care. This collaboration can also help to reduce the unintended consequences of treating pain.
The first is a guide to help you start the conversation. The second is a step-by-step tool for your patients to fill out and use in their conversation with you.
These free, downloadable tools will assist you in helping your patients discuss how to achieve improved pain control together and understand the basics of safe and effective pain management.
Power of creating a plan together
Understanding the concept of multimodal pain management is an essential first step to effectively use the plan and manage pain.
“Multimodal analgesia involves the use of multiple medications and techniques to treat pain to target different physiological reasons for pain,” said Esther Berhnofer, PhD, RN-BC, CPE, director of the master faculty and a member of the Board of Directors of the American Society for Pain Management Nursing. “Multimodal techniques are definitely more effective than single modality plans for most people because pain is a complex symptom or syndrome that involves physical and psychological mechanisms.”
The “Create a Multimodal Pain Management Plan” tool available on GetReliefResponsibly.com describes multimodal analgesia as well as the few simple steps to effectively co-create a plan with your patient, Bernhofer said.
As a certified pain educator, Bernhofer has published work ranging from the ethics of pain management to the physical environment and pain: light, mood, sleep and pain in med-surg patients.
“Multimodal pain management is an intentional, comprehensive and thoughtful approach that you don’t order every pain pill and treatment you think would help and add them together just to try it,” said Berhnofer, who works as an associate professor at the Francis Payne Bolton School of Nursing at Case Western Reserve University in Cleveland, where she teaches pain management classes for nurses and physicians.
“You carefully consider the source of the pain and suffering, what is important to the patient, and the risks versus benefits and create a careful plan,” she said.
The comprehensive, concise plan conveys three important steps to help assess your patients’ unique pain and have the conversation to implement a plan:
- Ask patients about their pain management preferences
- Consider and discuss the efficacy of over-the-counter pain relievers in multimodal analgesia
- Personalize each patient’s pain management plan
Ask patients their preferences
The first point is an important step that involves determining patients’ pain management preferences.
In a survey of 500 surgical patients 80% said they would prefer non-opioid medication for post-operative pain, but fewer than 25% of the same patients discuss this goal with their treatment provider.
The plan asks you to encourage your patients to participate in their own care by offering an opportunity to discuss their preferences.
Patients have an opportunity to discuss their concerns about medication side effects and alert you as their nurse as soon as they experience pain. These steps are integral to addressing patients’ overall pain management preferences.
Why you should consider over-the-counter pain relief
The second step encourages you to educate the patient on multimodal pain management and the role over-the-counter pain relievers, such as acetaminophen and NSAIDs, can play in effectively managing their pain.
American Pain Society guidelines recommend the use of OTC analgesics as part of an overall pain management plan for effectively managing post-operative pain.
The society advises this course of treatment along with the use of other modalities, such as opioids, topicals and non-pharmacological treatments.
For example, Bernhofer said a plan to use multimodal analgesia may include:
- Using muscle relaxants at night
- Taking an opioid for severe break-through pain
- Reducing inflammatory pain with a prescription NSAID
- Relaxing with yoga
“I believe that while acetaminophen and ibuprofen are excellent parts of multimodal pain management, they too have their limitations,” she said. “So, all things need to be considered.”
Personalize each patient’s pain
No two patients are alike. The third step — personalizing each patient’s pain management plan — is imperative.
This incorporates a patient’s goals for pain management and recovery targets while integrating the use of non-pharmacological therapies, if patients so desire.
American Pain Society guidelines discuss the provision of patient and family-centered care.
Individualizing pain management is essential because “pain is very complex, even when we think it’s simple,” Bernhofer said. “Generally, the more complex the pain syndrome, the more it requires multiple modes of treatment to be effective. Chronic pain syndromes like fibromyalgia or suffering for years with back pain, requires an attack at many different angles to provide relief.”
How to begin practicing multimodal pain management
It’s easier than you think to incorporate a multimodal pain management plan into your bedside practice.
Download the “Create a Multimodal Pain Management Plan” tool and familiarize yourself with the process so you can feel confident leading the conversation with your patients.
Next, practice discussing how a multimodal pain management plan works with colleagues, friends and family. Pay attention to their feedback and questions so you understand how to improve your communication.
This will ensure you are clearly explaining how pain relief can be achieved from over-the-counter pain relievers to prescriptions for opioids and the risks associated with each analgesic. Bernhofer adds that establishing trust can make patients more willing to try different modes of treatment.
Finally, start having the conversation with your patients. You should discuss multimodal pain management with your patients right after a pain assessment, so you can develop a treatment plan together, Bernhofer said.
Download and print the “Create Your Pain Management Plan” tool for patients and have them fill it out so you can personalize each patient’s pain relief plan.
“Comprehensive pain assessment is critically important,” she said. “It involves more than just choosing a number from zero to 10. It also involves understanding what and where the pain is, what makes it worse or better, what has worked for the patient before, and what is and is not acceptable to the patient.”