NURS6521: Pain Medication Discussion
NURS6521: Pain Medication Discussion
A patient is being seen in the emergency department for a sprained ankle and is given a drug to relieve pain. When a second dose of the pain medication is given, the patient develops redness of the skin, itching, and swelling at the site of injection of the drug. The most likely cause of this response is
1. Executive summary
The correct diagnosis and proper treatment of pain is an important public health concern. Millions of
people in the world with severe acute and chronic pain suffer because of the ignorance of doctors and
the lack of a standardized scientific approach.
World Health Organization (WHO) is committed to facilitate the adequate treatment of pain by
legitimate use of opioid analgesics. WHO through its Access to Controlled Medications Programme
plans to assist Member States to achieve a balance between the use of controlled substances for
legitimate medical purposes and the prevention of their abuse. WHO through normative guidelines on
the treatment of all types of pain can provide guidance to governments, institutions and health care
professionals for policy, legislation and practice.
A Delphi study was done to identify the topics to be included in WHO guidelines and the number of
guidelines that need to be developed. Experts and office bearers of professional bodies related to pain
were identified in order to get the views of the international medical and pharmaceutical communities
on the best solution for the development of one or more guidelines. Fifty six experts were approached
through e-mails, telephone or personal interview. Forty six (82%) responded.
All experts, including representatives of the professional bodies, urged that WHO should take a lead in
this area. WHO has normative clinical and policy guidelines on opioid availability only for cancer
related pain. These guidelines are widely used and have served as a major tool for policy change and
as an educational tool on the appropriate use of opioids for pain management. Similar to the cancer
pain relief guidelines, the new WHO guidelines could serve as a guide to health care professionals
from all disciplines, in addition to policy makers and regulatory authorities, for legitimate use of
opioids in pain management and facilitating their legal access.
The majority of experts favored that WHO should develop three distinct guidelines, keeping broad
distinctions between acute and chronic pain: 1) Acute pain, 2) Chronic malignant pain (including pain
in cancer and HIV patients) and 3) Chronic non-malignant pain. They should include
recommendations for specific age groups, clinical situations and resource settings. Examples include
pain assessment of patients who have difficulty communicating and the treatment of patients with comorbidities, substance abuse, terminal stage (end of life), emergencies and who need home-based care.
The best option chosen was to have a total of three guidelines for adults, with specific issues for
children and older adults mentioned as a chapter, paragraph or appendix. However, this option was not
acceptable to many paediatricians. It remained an issue whether there should be separate guidelines for
children since there are only a few types of pain, especially chronic pain, that are common in both
adults and children (e.g. sickle cell pain, burns, cancer, HIV). In addition, the assessment of pain, types
and doses of medicines, route of administration and adverse effects are different in very small children.
The WHO Guideline Steering Group of the Access to Controlled Medications Programme should
consider both options. Although widest acceptability by the medical community is the most important
consideration for widespread use of guidelines, the final decision by WHO will also depend upon the
cost involved in terms of money, time frame and expertise.
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