1. mildpain(score0-3)
STEP 1
As ordered:
Acetaminophen(no more
than 4000mg totalper day)
NSAIDS (if appropriate)
ALTERNATIVETHERAPIES:
Reposition, cold or heat,
massage, softmusic, dim
lights
If pain not relieved and
meds areordered go to Step
2. If no orders, notify
physician.
moderatepain(score4-6)
STEP 2
As ordered:
Low doses of oral
opioids/narcotics
Muscle relaxers(forcramps
and spasms);
Antidepressants;
anticonvulsants(nervepain)
+ STEP 1
If pain not relieved and
meds areordered, go to
Step 3. If no orders, notify
physician.
severepain(score7-10)
STEP 3
As ordered:
IV or PO opioids/narcotics
as ordered
+ STEP 1
+STEP 2
Notify physicianif
pain not relieved
Best Practices for Decision Making in
Pain Management
Decisions are based on best available evidence,
your clinical expertise, and patient preferences

2. Jane Shannon, BSN, RNC-NIC, MSN candidate, Clinical Nurse Leader Resident (Elmhurst College) 2014
References
Apfelbaum, J., Ashburn, M., Connis, R., Gan, T., Nickinovich, D. (2012). Practice guidelines for acute pain management in the
perioperative setting: An updated report by the American Society of Anesthesiologists task force on acute pain management.
Anesthesiology, 116(2), 248-273
Crowe, L., Chang, A., Fraser, J., Gaskill, D., Nash, R., Wallace, K. (2008). Systematic review of the effectiveness of nursing
interventions in reducing or relieving post-operative pain. International Journal of Evidenced-based Healthcare, 6 (4), 165-224
Joint Commission Resources (2012).Pain Management: A systems approach to improving quality and safety. Oakbrook terrace, IL:
Lauwers & McCleanWhitehurst
National Association of Orthopedic Nurses, (2013) Retrieved from: http://www.orthonurse.org/p/cm/ld/fid=4