{
  "name": "Acute Pain & Pain Management",
  "slug": "acute-pain",
  "url": "https://nursingplex.com/care-plans/acute-pain",
  "category": "Basic Nursing & General Care Plans",
  "summary": "Short-lived pain from injury, surgery or disease; managed with timed assessment, multimodal analgesia and non-drug comfort measures.",
  "nursing_diagnoses": [
    "Acute pain",
    "Impaired comfort",
    "Anxiety"
  ],
  "overview": [
    "Acute pain is a protective, time-limited experience that begins with an identifiable injury, procedure or disease process and normally resolves as tissue heals. It is whatever the patient says it is, occurring whenever they say it does — no vital sign, facial expression or lab value overrides the self-report.",
    "Unrelieved acute pain is not simply uncomfortable. It raises catecholamines and cortisol, drives tachycardia and hypertension, splints breathing so atelectasis and pneumonia follow, delays ambulation and gut motility, and increases the chance the pain becomes chronic through central sensitization. Treating pain early and adequately is therefore a physiologic intervention, not a courtesy.",
    "Modern management is multimodal: scheduled non-opioid analgesia (acetaminophen, NSAIDs when not contraindicated), regional or local techniques, opioids reserved for moderate-to-severe pain at the lowest effective dose and duration, and non-pharmacologic measures used as genuine adjuncts. Anticipate and premedicate before painful activity rather than chasing pain after it peaks."
  ],
  "key_facts": [
    {
      "label": "Gold standard",
      "text": "The patient's self-report using a consistent scale (0–10 numeric, Wong-Baker FACES, or FLACC/PAINAD for nonverbal patients)."
    },
    {
      "label": "Reassess timing",
      "text": "About 15–30 minutes after IV analgesia and 60 minutes after oral dosing, and document the effect."
    },
    {
      "label": "Opioid red flag",
      "text": "Sedation precedes respiratory depression — a patient hard to arouse needs holding of the next dose, not just monitoring."
    },
    {
      "label": "Multimodal principle",
      "text": "Combining agents with different mechanisms lowers total opioid dose and side effects."
    },
    {
      "label": "Never use",
      "text": "Meperidine for ongoing pain (normeperidine accumulates and causes seizures) or IM injections for routine dosing."
    }
  ],
  "nursing_priorities": [
    "Believe and quantify the pain with a consistent, developmentally appropriate tool.",
    "Identify and treat the underlying cause, not just the symptom.",
    "Deliver analgesia around the clock during the peak-pain window rather than as needed only.",
    "Prevent predictable side effects — constipation, nausea, sedation, respiratory depression.",
    "Premedicate before dressing changes, ambulation and therapy.",
    "Layer in non-drug comfort measures and reposition frequently.",
    "Restore function: deep breathing, early mobility, sleep and appetite are the real endpoints.",
    "Teach a realistic pain goal and safe medication use before discharge."
  ],
  "assessment": {
    "subjective": [
      "Description of location, quality, radiation, onset, duration and intensity",
      "What makes the pain better or worse, and what has helped before",
      "The patient's acceptable comfort–function goal number",
      "Sleep loss, appetite change, irritability or fear of movement",
      "Concern about addiction or reluctance to ask for medication"
    ],
    "objective": [
      "Guarding, grimacing, moaning, restlessness or rigid posturing",
      "Tachycardia, hypertension, tachypnea, diaphoresis (may be absent in prolonged pain)",
      "Shallow, splinted respirations and a weak cough",
      "Refusal or reluctance to move, ambulate or participate in therapy",
      "Sedation score and respiratory rate after opioid dosing",
      "Wound, incision, distention or deformity that explains the pain"
    ],
    "related_factors": [
      "Surgical incision, trauma or invasive procedures",
      "Tissue inflammation, ischemia or distention of a hollow organ",
      "Muscle spasm and involuntary guarding",
      "Positioning, dressing changes, drains, tubes and immobility",
      "Anxiety, fear and sleep deprivation lowering pain threshold"
    ]
  },
  "goals": [
    "The client will report pain at or below their stated comfort–function goal within one hour of intervention.",
    "The client will demonstrate relaxed body posture, unlabored breathing and ability to rest or sleep.",
    "The client will participate in deep breathing, ambulation and therapy without pain as a limiting factor.",
    "The client will remain free of preventable analgesic complications such as oversedation and constipation.",
    "The client will verbalize the correct name, dose, schedule and side effects of prescribed analgesics before discharge."
  ],
  "interventions": [
    {
      "title": "1. Assessing pain accurately",
      "points": [
        "Assess pain on admission, at regular intervals, with each new report, and after every intervention — a single number without reassessment is meaningless.",
        "Use the same scale every time for a given patient; switching tools makes trends uninterpretable.",
        "Use behavioral tools (FLACC, PAINAD, CPOT) for infants, dementia or intubated patients, since the absence of a verbal report is not the absence of pain.",
        "Explore the full picture — location, radiation, quality, timing and aggravating factors — because a change in character can signal a new complication such as compartment syndrome or perforation.",
        "Accept the report even when vital signs are normal; physiologic markers adapt within hours while pain persists.",
        "Document the pain goal that lets the patient breathe deeply, sleep and walk, and treat toward that number."
      ]
    },
    {
      "title": "2. Pharmacologic management",
      "points": [
        "Give scheduled non-opioids such as acetaminophen (respecting the 3–4 g/day ceiling and hepatic status) and NSAIDs, which lower opioid requirements substantially.",
        "Screen NSAIDs against bleeding risk, renal function, gastric ulcer history and cardiac disease before administering.",
        "Use the IV route for severe acute pain because of predictable onset; avoid IM injections, which are painful and absorbed erratically.",
        "Administer around the clock during the expected peak, then taper to as-needed dosing as the injury heals.",
        "Teach patient-controlled analgesia clearly: only the patient presses the button — never a family member — and the pump's limits are the safety mechanism.",
        "Monitor sedation level with every opioid dose using a sedation scale; increasing sedation is the earliest warning of respiratory depression, and naloxone should be available.",
        "Start a bowel regimen with the first opioid dose; opioid-induced constipation does not develop tolerance.",
        "Add adjuvants where indicated — gabapentinoids for neuropathic burning, muscle relaxants for spasm, local anesthetic infiltration or nerve blocks."
      ]
    },
    {
      "title": "3. Non-pharmacologic comfort measures",
      "points": [
        "Apply cold to acute injury and swelling in the first 24–48 hours to reduce inflammation and nerve conduction, then heat for muscle spasm and stiffness.",
        "Splint the incision with a pillow before coughing, deep breathing or turning to reduce tension on the wound.",
        "Reposition every two hours, support limbs, elevate edematous extremities and smooth the linens.",
        "Use distraction, music, guided imagery, slow breathing and relaxation techniques — most effective for mild to moderate pain and before procedures.",
        "Cluster nursing care to protect blocks of rest; sleep deprivation measurably lowers pain threshold.",
        "Reduce environmental stressors: dim lights, lower noise, allow supportive family presence."
      ]
    },
    {
      "title": "4. Procedural and movement-related pain",
      "points": [
        "Premedicate 20–30 minutes before dressing changes, drain removal, chest tube manipulation or physical therapy so the peak effect coincides with the procedure.",
        "Explain each step before touching the patient — anticipated pain is tolerated far better than surprise pain.",
        "Allow the patient to call a pause during procedures; perceived control lowers reported intensity.",
        "Coordinate therapy sessions with the analgesic schedule rather than the unit routine."
      ]
    },
    {
      "title": "5. Preventing complications of unrelieved pain",
      "points": [
        "Encourage incentive spirometry and deep breathing hourly; splinted respirations cause atelectasis and pneumonia.",
        "Mobilize early to prevent venous thromboembolism, ileus and deconditioning.",
        "Monitor for urinary retention and constipation, both common with opioids and immobility.",
        "Watch for signs the pain is becoming neuropathic — burning, shooting, allodynia — and escalate to adjuvant therapy early."
      ]
    },
    {
      "title": "6. Education and psychosocial support",
      "points": [
        "Correct the belief that pain must be endured or that asking for medication signals weakness or addiction risk.",
        "Teach the patient to report pain before it becomes severe, since escalating pain requires more medication to control.",
        "Review at home: what each medication is for, maximum daily acetaminophen across combination products, avoiding alcohol, and safe storage and disposal of opioids.",
        "Give clear warning signs to report: pain that suddenly worsens or changes character, fever, wound drainage, numbness or inability to move a limb."
      ]
    }
  ],
  "patient_teaching": [
    "Take analgesics on schedule during the first days rather than waiting for pain to peak.",
    "Do not exceed the daily acetaminophen limit; check every combination product for hidden acetaminophen.",
    "Expect constipation with opioids — take the prescribed stool softener, drink fluids and stay active.",
    "Avoid alcohol, sedatives and driving while taking opioids.",
    "Use ice, heat, splinting and repositioning together with medication, not instead of it.",
    "Report pain that is unrelieved by the prescribed regimen, or new numbness, weakness, fever or wound changes.",
    "Store opioids locked and return unused tablets to a take-back program."
  ]
}