Assessment and Management of Pain
Purpose and scope
This guideline provides evidence-based recommendations for nurses and other members of the interprofessional team who are assessing and managing people with the presence or risk of any type of pain.
We’ve designed this guideline to help nurses and their interprofessional teams become more comfortable, confident and competent. A specific focus: building the core competencies of nurses to help them be more effective in assessing and managing of pain without focusing on the type or origin of the pain. It is intended for use in all domains of health care and public health, including clinical work, administration and education.
Do you want to learn about and implement the most- up-to-date evidence-based recommendations on this topic with your colleagues? Download and share the full best practice guideline (BPG), Assessment and Management of Pain.
See below for a snapshot of the recommendations from this BPG. We strongly suggest you review the full BPG before implementing the recommendations and good practice statements. The BPG also includes further resources to support implementation and evaluation.
Recommendation 1.1: Screen for the presence, or risk of, any type of pain:
- On admission or visit with a health-care professional;
- After a change in medical status; and
- Prior to, during and after a procedure.
Recommendation 1.2: Perform a comprehensive pain assessment on persons screened having the presence, or risk of, any type of pain using a systematic approach and appropriate, validated tools.
Recommendation 1.3: Perform a comprehensive pain assessment on persons unable to self-report using a validated tool.
Recommendation 1.4: Explore the person’s beliefs, knowledge and level of understanding about pain and pain management.
Recommendation 1.5: Document the person’s pain characteristics.
Recommendation 2.1: Collaborate with the person to identify their goals for pain management and suitable strategies to ensure a comprehensive approach to the plan of care.
Recommendation 2.2: Establish a comprehensive plan of care that incorporates the goals of the person and the interprofessional team and addresses:
- Assessment findings;
- The person’s beliefs and knowledge and level of understanding; and
- The person’s attributes and pain characteristics.
Recommendation 3.1: Implement the pain management plan using principles that maximize efficacy and minimize the adverse effects of pharmacological interventions including:
- Multimodal analgesic approach;
- Changing of opioids (dose or routes) when necessary;
- Prevention, assessment and management of adverse effects during the administration of opioid analgesics; and
- Prevention, assessment and management of opioid risk.
Recommendation 3.2: Evaluate any non-pharmacological (physical and psychological) interventions for effectiveness and the potential for interactions with pharmacological interventions.
Recommendation 3.3: Teach the person, their family and caregivers about the pain management strategies in their plan of care and address known concerns and misbeliefs.
Recommendation 4.1: Reassess the person’s response to the pain management interventions consistently using the same re-evaluation tool. The frequency of reassessments will be determined by:
- Presence of pain;
- Pain intensity;
- Stability of the person’s medical condition;
- Type of pain e.g. acute versus persistent; and
- Practice setting.
Recommendation 4.2: Communicate and document the person’s responses to the pain management plan.
Recommendation 5.1: Educational institutions should incorporate this guideline, Assessment and Management of Pain (3rd ed.), into basic and interprofessional curricula for registered nurses, registered practical nurses and doctor of medicine programs to promote evidence-based practice.
Recommendation 5.2: Incorporate content on knowledge translation strategies into education programs for health-care providers to move evidence related to the assessment and management of pain into practice.
Recommendation 5.3: Promote interprofessional education and collaboration related to the assessment and management of pain in academic institutions.
Recommendation 5.4: Health-care professionals should participate in continuing education opportunities to enhance specific knowledge and skills to competently assess and manage pain, based on this guideline, Assessment and Management of Pain (3rd ed.).
Recommendation 6.1: Establish pain assessment and management as a strategic clinical priority.
Recommendation 6.2: Establish a model of care to support interprofessional collaboration for the effective assessment and management of pain.
Recommendation 6.3: Use the knowledge translation process and multifaceted strategies within organizations to assist health-care providers to use the best evidence on assessing and managing pain in practice.
Recommendation 6.4: Use a systematic organization-wide approach to implement Assessment and Management of Pain (3rd ed.) best practice guideline and provide resources and organizational and administrative supports to facilitate uptake.
Disclaimer: These guidelines are not binding for nurses, other health providers or the organizations that employ them. The use of these guidelines should be flexible and based on individual needs and local circumstances. They constitute neither a liability nor discharge from liability. While every effort has been made to ensure the accuracy of the contents at the time of publication, neither the authors nor the Registered Nurses’ Association of Ontario (RNAO) gives any guarantee as to the accuracy of the information contained in them or accepts any liability with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work.
Pain bibliography.pdf (479k)
Pain search strategy.pdf (278k)
Current edition published 2013.
About the next edition
The Registered Nurses' Association of Ontario (RNAO) is developing a fourth edition of this best practice guideline (BPG), with the working title Assessment and Management of Pain. The anticipated publication date is 2024.
This new edition will replace Assessment and Management of Pain (2013).