Registered Nurses' Association of Ontario

Implementing the Pain Management Plan

  • A multimodal analgesic approach or pharmacologic intervention includes non-opioid analgesics such as non-steroidal anti-inflammatory drugs [NSAIDs]; opioids (e.g., morphine) and adjuvant medications (e.g., antidepressants, anticonvulsants, anaesthetic agents) that act through different mechanisms to modulate a person’s pain
  • To maximize efficacy and minimize the adverse effects of a multimodal analgesic approach nurses should use the following principles to guide practice:
  1. Use the most efficacious and least invasive way to administer analgesics.
  2. Consider a multimodal analgesic approach to pain management:
  • Use non-opioids to manage mild to moderate pain (acetaminophen or NSAIDs);
  • Use opioids in combination with non-opioids to manage moderate to severe pain; and
  • Use advanced modalities such as patient-controlled analgesia [PCA], epidural, intrathecal, and nerve blocks, which may provide superior analgesia to manage persistent, non-malignant or cancer pain and acute pain experienced from major surgical procedures or injury
  1. Advocate for the most effective dosing schedule, considering the medication(s) duration of onset, effect(s) and half-life. The optimal analgesia dose is one that effectively relieves pain with minimum adverse effects.
  2. Recognize potential contraindications, such as co-morbidities or drug-drug interactions, related to the person’s clinical condition.
  3. Titrate any pain medications to achieve the maximum effectiveness whilst minimizing adverse effects.
  4. Anticipate and manage the adverse effects from pharmacologic interventions.
  5. Consider consulting the interprofessional team or pain-management experts for complex pain situations.
Clinical Management
Assessment and Management of Pain - 3rd Edition
Point of Care Resources