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Why you should read this article: • To recognise the importance of undertaking comprehensive pain assessments for all patients who have undergone a surgical procedure • To be aware of various tools that could assist in assessing the type, nature and intensity of a patient’s pain • To support you with identifying when a patient may require appropriate pain management interventions. Rationale and key points: Acute post-operative pain is common among patients in secondary care settings, and the alleviation of this pain is a principal responsibility for all healthcare professionals, including nurses. To achieve this, it is essential to regularly undertake comprehensive pain assessments, using validated pain assessment tools, for all patients who have undergone a surgical procedure. Inadequate pain assessment may lead to ineffective or inappropriate pain management, which can adversely affect the patient’s recovery and increase their risk of developing chronic pain. •  Pain is a subjective experience and therefore requires individualised, comprehensive assessment and management interventions. •  The assessment process for patients with acute pain is fundamental to understanding the patient’s current status, informing differential diagnoses regarding the underlying cause of the pain, providing appropriate treatment and monitoring, and evaluating the effectiveness of treatment. •  Pain assessment should not be undertaken as a one-off care activity; it should be completed whenever a patient reports pain and repeated following pharmacological and/or non-pharmacological interventions. Reflective activity: ‘How to’ articles can help you to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: •  How this article might improve your practice when undertaking a comprehensive pain assessment with patients experiencing acute post-operative pain. •  How you could use this information to educate nursing students or colleagues on the appropriate actions to take when undertaking a comprehensive pain assessment with patients experiencing acute post-operative pain. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your knowledge of complex regional pain syndrome and its effects • To recognise the challenges involved in assessing and diagnosing complex regional pain syndrome • To understand the management interventions available for patients with complex regional pain syndrome Complex regional pain syndrome is a rare and not well understood chronic pain condition that can affect anyone, irrespective of age and sex. It is important that nurses and the wider healthcare team are aware of the symptoms and recommended management of this condition, with timely diagnosis and appropriate rehabilitation being particularly important. This article provides an overview of complex regional pain syndrome and explains what is involved in the diagnosis and treatment of this condition. Understanding the complexity of the condition and the relevant management guidelines will enable nurses to provide effective care and support for patients. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To refresh your knowledge of the principles of pain assessment and management • To identify useful pain assessment and management tools and resources • To enhance your awareness of the adverse effects and complications of opioids Pain is a distressing, subjective and complex phenomenon that all nurses will encounter in their clinical practice. Effective pain management requires nurses to undertake a structured assessment to identify the probable causes of pain and guide management. Interventions used to reduce pain can be varied and multimodal. This article provides an overview of pain including its definition, classifications, assessment and management. It emphasises the importance of a person-centred approach to care which reflects Margo McCaffery's seminal quote that pain is 'whatever the experiencing person says it is'. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your awareness of the barriers that may prevent you from recognising acute pain in patients • To recognise how you can overcome the barriers that prevent the recognition of pain • To understand the components of a comprehensive pain assessment This article considers two areas of practice that are fundamental to the provision of high-quality nursing care for people experiencing acute pain: the initial recognition of pain, and the formal assessment of pain. The initial recognition of a patient's pain is a subject that is frequently overlooked in the literature. However, if nurses are unable to identify that a patient is experiencing pain, then a formal pain assessment may not take place, which in turn negatively affects the quality of any subsequent pain management. This article explores some of the barriers to the initial recognition of pain and examines how a formal pain assessment can support optimal patient care. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the indications for epidural analgesia • To familiarise yourself with the complications associated with epidural analgesia • To improve your knowledge of the nursing care of people receiving epidural analgesia Epidural analgesia continues to have an important role in the management of acute pain in post-operative settings. Although its use in clinical practice has declined, it continues to demonstrate superior analgesia effect compared with parenteral opioids. However, despite these benefits, epidural analgesia requires additional monitoring to ensure the timely identification of significant complications, such as haematoma and abscess. This article details the nursing care and management of adults receiving epidural analgesia in post-operative settings. It also outlines the main complications that may occur and how these can be managed. [ABSTRACT FROM AUTHOR]

AUTH Why you should read this article: • To refresh your knowledge of the mode of action, side effects and risks of opioids • To enhance your awareness of the safety implications associated with the use of prescribed opioids • To understand the role of the nurse in caring for and supporting patients who are taking opioids Opioids are powerful analgesics that are derived from the opium poppy plant. They are recognised as central in the management of acute pain and cancer pain, but concerns about long-term use have resulted in recommendations that they should be used with caution in the management of chronic pain. Opioids have associated side effects and risks, but these may be exaggerated and some healthcare professionals can be unnecessarily cautious and withhold the use of opioids, even in cases where these medicines may be beneficial. It is important that nurses understand the pharmacology, side effects and risks of opioids, so they can ensure these medicines are administered safely. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise the effects chronic pain can have on a person's life • To understand the range of management interventions available for chronic pain • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Chronic pain can have significant physical, psychological and social effects on a person's life, as well as on their families and friends. However, it is often not well-recognised or understood, which can lead to further harm. Therefore, an individualised, person-centred approach to chronic pain is essential to accurately assess pain and to develop an appropriate treatment plan. This article outlines the biomedical and psychosocial factors that can influence an individual's pain experience that should be considered as part of the assessment and management of chronic pain, and explores the assessment tools available to assist in this process. It also discusses the management options available for chronic pain, including neural blockade and analgesics, as well as non-pharmacological options such as psychological approaches, physical activity and exercise, and complementary and alternative therapies. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise that pain is a subjective experience that can be challenging to assess and manage • To develop an awareness of the various pain assessment tools available • To understand how you can observe patient behaviours that may indicate pain Pain is a personal, individual and subjective experience. The complex and dynamic nature of pain makes its assessment and management challenging for healthcare professionals. Various pain scales are available that can assist in identifying the patient's experience of pain; however, these tend to reduce this experience to a measure of pain intensity. The use of pain scales also requires patients to communicate and describe their pain; when this is not possible, it is necessary for healthcare professionals to observe patient behaviours that may indicate pain. Various observational pain assessment tools have been developed to assist in recognising and assessing pain. This article discusses the various pain scales and observational pain assessment tools that are available, and the evidence to support their use. [ABSTRACT FROM AUTHOR]

Nurses practising in almost any area of healthcare may encounter individuals who are considering acupuncture, particularly those caring for people who are experiencing chronic pain. Acupuncture is a complex intervention and in traditional practice is not simply the insertion of needles, as some people believe. This article provides a historical understanding of acupuncture, outlining some of the differences between styles of practice that may be relevant when selecting an acupuncturist. It also examines the issues that should be considered when assessing the evidence base for acupuncture. [ABSTRACT FROM AUTHOR]

Acute pancreatitis is a potentially life-threatening condition primarily associated with gallstones or prolonged and excessive alcohol intake. Although the initial triggers of the condition can vary, the resulting pathophysiology is broadly similar irrespective of the cause. This article explores the pathophysiology of the main causes of acute pancreatitis, and discusses nursing management of the condition in the acute setting and the long-term issues to consider. It also outlines the conservative management of the condition, which includes pain management, provision of fluids and nutritional care. In the management of acute pancreatitis, nursing care can often overlap with medical management, especially as the condition deteriorates. Therefore, it is important that nurses develop comprehensive knowledge of the management of acute pancreatitis. [ABSTRACT FROM AUTHOR]

Effective management of acute and chronic pain is an important aspect of nursing practice. Relieving patients' pain requires nurses to have an understanding of the latest evidence-based approaches, which will enable them to assess pain, implement appropriate management strategies and monitor their effectiveness. This article outlines the developments in evidence-based guidelines and recommendations for the pharmacological management of acute and chronic pain, including migraine, and in the use of analgesics such as opioids. It also discusses pain management in specific groups such as children and young people, and older people. [ABSTRACT FROM AUTHOR]

Chronic pain is experienced by between one third and one half of the UK population. Nurses should ensure that patients' pain is assessed and managed when they present to hospital, including pre-existing chronic pain and acute pain as a result of trauma or surgical interventions. Acute pain that is inadequately managed may result in chronic pain, impeding the patient's return to normal function and daily activities. Depression and increasing age affect the likelihood of patients experiencing chronic pain. Nurses should be familiar with the pain assessment tools available for use with older people and be aware of the potential issues of polypharmacy and altered sensitivity to medication in older people. Nurses can manage patients' pre-existing chronic pain, or likely post-operative pain, by working collaboratively with patients, their carers or families where appropriate, and the multidisciplinary team. For patients undergoing surgery, this cooperation should begin preoperatively and continue into the post-operative period. [ABSTRACT FROM AUTHOR]

Accurate assessment of pain in children and young people is an essential nursing skill that forms the basis of any pain management intervention. This article outlines the different tools available to assess acute and chronic pain in children and young people. Validity and reliability of these tools is discussed and the importance of factors such as level of cognitive development and age are emphasised. [ABSTRACT FROM AUTHOR]

Pain is a significant problem in patients with cancer. Understanding the causes and types of cancer pain, thorough pain assessment and use of individualised pain management strategies can help to improve quality of care and pain relief for patients with cancer. This article provides an overview of cancer pain and the effects this may have on patients and their carers. The nurse's role in understanding pain and interventions that may help to minimise pain are discussed. Assessment and management of cancer pain will be explored in a subsequent article. [ABSTRACT FROM AUTHOR]

Epidural analgesia is a common technique used to manage acute pain after major surgery and is viewed as the 'gold standard'. When managed effectively, epidural analgesia is known to reduce the risk of adverse outcomes following major surgery. There are two main classes of medications used in epidural analgesia: opioids and local anaesthetics. Both of these drugs are beneficial in reducing or eliminating pain, but are also responsible for the common side effects associated with this method of pain relief. There are also some rare and potentially fatal side effects of epidural therapy. The nurse's role is to assess and monitor patients carefully and report and respond to any concerns. [ABSTRACT FROM AUTHOR]

This article explores the role of medicines in the management of acute pain. The main categories of analgesic drugs are outlined and the different routes of administration are explored. The characteristics and precautions associated with the different classes of medicines are also highlighted. [ABSTRACT FROM AUTHOR]