IASP Curriculum Outline on Pain for Nursing

Please tell us how you plan to use this document by answering two quick questions. This information will help IASP determine how the curricula are being used. Thank you for your support of this effort.
*IASP members: Please log in to answer the survey. Nonmembers: Please create a web account to answer the survey.

Task Force Members

Alison Twycross (chair), Robyn Quinn, Marit Leegaard, Marina Salvetti, Deb Gordon

With thanks to our expert reviewers

Natasha Ascott, UK; Erica Brandão de Maraes, Brazil; Keela Herr, USA; Geana Kurita, Brazil; Tone Marte Ljosaa, Norway; Cibele Pimenta, Brazil; Judith Paice, USA; Meriel Swan, UK; Amelia Swift, UK; Karen Torvik, Norway; Berit T. Valeberg, Norway; Heather Young, USA.

Outline Summary

Introduction
Principles
Objectives
Curriculum Content Outline
 I. Multidimensional Nature of Pain
 II. Pain Assessment and Measurement
 III. Management of Pain
 IV. Clinical Conditions
References

Introduction

The widespread prevalence of pain demonstrates the need for comprehensive pain education for all health-care professionals. Yet not all require the same type of pain-related knowledge and skills. IASP encourages all Nursing programs to utilize the following curriculum outline to embed pain education and training. As with other health professions, an objective of curricula is to instil the knowledge and skills necessary to advance the science and management of pain as part of an interprofessional team. The desired outcomes of education emphasize critical competencies that support the humanistic aspects of health care and the learner’s capacity to successfully carry out tasks in the real world. The fundamental concepts and complexity of pain include how pain is observed and assessed, collaborative approaches to treatment options, and application of pain competencies across the lifespan in the context of various settings, populations, and care-team models.

Every nurse should be able to assess and manage pain. This curriculum outlines the optimal knowledge and skills related to pain and its management for entry-level registered nurses worldwide. However, knowledge alone is not enough. Theoretical knowledge must be applied in practice. Assessment strategies should test application in practice rather than just knowledge retention. The application of knowledge in practice can be enhanced through the use of innovative teaching strategies such as case studies, and clinical practicum and placements across populations and settings.

Pain is a multidimensional and complex phenomenon that requires comprehensive, ongoing assessment and effective management. The multidimensional nature of pain requires an interprofessional approach to assessment and management. All professionals need to serve as advocates for the person in pain and ensure that pain treatment is based on ethical principles and evidence-based standards and guidelines. Nurses play a critical role in effective pain management because they have frequent contact with patients in a variety of settings (e.g., home, hospital, outpatient clinic, community). This frequent contact places the nurse in a unique position to:

  1. Identify patients who have pain
  2. Perform a comprehensive pain assessment, including its impact on the patient and the patient’s family members
  3. Initiate actions to manage the pain and evaluate the effectiveness of those actions

Nurses’ central role and responsibility in the assessment and management of pain means that they are required to be knowledgeable about pain mechanisms, the epidemiology of pain, barriers to effective pain control, frequently encountered pain conditions, variables that influence a patient’s perception of and response to pain, valid and reliable methods of clinical pain assessment, and a range of available methods for the alleviation of pain.

Principles

The following principles guide the pain curriculum for entry-level nurses:

  1. Pain is viewed as a biopsychosocial phenomenon that includes social, psychological, and biological factors.
  2. Pain may be acute, persistent, or a combination of acute and chronic. The etiology of the pain will guide the development of the pain-management plan.
  3. Pain must be assessed in a comprehensive and consistent manner using valid and reliable assessment tools that are appropriate to the patient’s age, communication skills, and medical condition (e.g., tools for neonates or for dementia).
  4. Patients have a right to the best possible pain management.
  5. Pain assessment and management are integral aspects of nursing care and should involve patients and their family members in decision making.
  6. Pain assessment and management should be recorded in a clear and readily accessible manner.
  7. Patient and family education about pain and its management are essential components of nursing care.
  8. Nurses are essential members of the pain-management team.

Objectives

Upon completion of this pain curriculum, the entry-level nurse will be able to:

  1. Apply current knowledge of anatomy, physiology, pharmacology, psychology, and sociology to the assessment and management of people with pain
  2. Distinguish between different types of acute, persistent, and breakthrough pain in terms of mechanisms, assessment, and management
  3. Demonstrate an understanding of the consequences of unrelieved pain
  4. Engage in evidence-based pain assessment and care planning that takes into account social, psychological, and biological components of the pain condition
  5. Identify barriers to effective pain assessment and management related to the patient, their family, health-care professionals, and the organization and intervene to address these
  6. Recognize individuals who are at risk for under-treatment of their pain (e.g., individuals who are unable to self-report pain, neonates, cognitively impaired) and put appropriate strategies in place to address this
  7. Use valid and reliable pain-assessment tools that are appropriate to the needs of the individual patient and the demands of the care situation
  8. Provide patients and family members with information about a variety of pain-management interventions
  9. Appraise appropriateness prior to administering prescribed analgesics and evaluate their effects on patients’ pain and function
  10. Prevent and manage common adverse effects associated with pain treatment
  11. Differentiate physical dependence, misuse, tolerance, and addiction/substance-use disorder
  12. Explain the reasons for non-adherence to pain treatments and discuss strategies that can be used to overcome this
  13. Identify and deliver a range of physical and psychological pain-relieving measures (e.g., positioning, information, relaxation techniques, distraction) to decrease patients’ pain
  14. Demonstrate effective collaboration as a member of the interprofessional team, which may include patients and family caregivers, to identify clearly defined, realistic, and agreed-upon goals for pain management
  15. Accurately document pain assessments
  16. Demonstrate empathetic, compassionate, and effective communication with patients, family caregivers, and members of the interprofessional team
  17. Reflect on their practices and identify ways to improve care for people with pain
  18. Identify gaps in their own knowledge and competencies and take relevant steps to address this

Curriculum Content Outline

  1. Multidimensional Nature of Pain
    1. Definitions of pain and associated anatomy and physiology
      1. Types of pain based on duration
        1. Acute pain
        2. Persistent postsurgical pain
        3. Breakthrough pain
        4. Chronic pain
    2. Types of pain based on mechanism
      1. Nociceptive pain (somatic, visceral)
      2. Nociplastic pain
      3. Neuropathic pain
    3. Anatomy and physiology of pain
      1. The role of the nervous system in the in the transduction, transmission, perception, and modulation of pain, including contemporary theories about pain
    4. Biological factors
      1. Age
      2. Sex
      3. Cognitive development/impairment
      4. Genetics
    5. Psychological factors
      1. Cognitive (control, self-efficacy, catastrophizing, beliefs, appraisals, expectancies)
      2. Affective (depression, anxiety, anger, personality)
      3. Coping style/skills
    6. Social factors
      1. Culture
      2. Family learning
      3. Gender
      4. Ethnicity
    7. Impact of unrelieved pain
      1. Physical effects
      2. Psychological effects
      3. Social and other effects of unrelieved pain (e.g., spiritual)
      4. Impact of acute pain on recovery
      5. Development of persistent pain
  2. Pain Assessment and Measurement
    1. Pain assessment across the lifespan
      1. Infants, children, and adolescents
      2. Older adults
      3. Cognitively impaired or developmentally disabled individuals of all ages
      4. Individuals with multi-morbid affective or psychological conditions (e.g., anxiety, depression, catastrophizing)
      5. Individuals who speak a language other than that spoken by the health-care professionals
      6. People with addiction/substance-use disorder
      7. Patients who are unable to communicate effectively due to disease or treatment
    2. Feasibility, validity, reliability, sensitivity, and clinical utility of different pain-assessment methods for specific groups and clinical settings
    3. Assessment of patient’s coping behavior and skills
    4. Methods to routinely screen for pain, perform a comprehensive pain assessment, and reassess following interventions, including appropriate timing and documentation
    5. Patients at risk of inadequate pain assessments and effective pain management
    6. Barriers to effective pain management
  3. Management of Pain
    1. Use appropriate pharmacologic pain-relieving interventions
      1. Goals of pain management
      2. Concept of multimodal analgesia
      3. Decision making to administer “pro re nata (prn) analgesic drugs
      4. Pharmacologic interventions for pain management for non-opioid and opioid analgesics and adjuvant drugs:
        1. Mechanisms of action
        2. Indications
        3. Dose range
        4. Onset and peak duration of action
        5. Adverse effects
        6. Interactions with other drugs
        7. Concept of equianalgesia
      5. Different methods for drug delivery available:
        1. Oral/enteric
        2. Intranasal
        3. Parenteral (intravenous or subcutaneous, infusion devices, patient-controlled analgesia)
        4. Transdermal
        5. Transmucosal/buccal
        6. Topical
        7. Regional
      6. Developmental and age-specific issues
      7. Disease-specific therapies (e.g., anticancer therapies)
      8. Tolerance, physical dependence, and addiction/substance-use disorder and the difference between these terms
      9. Patient, family, clinician, and organizational barriers to effective pain management and awareness of strategies that can be used to address these
      10. Knowledge of the placebo effect
    2. Use appropriate non-pharmacologic interventions for pain management
      1. Physical strategies (e.g., exercise, turning and positioning, massage, heat, cold, hydrotherapy)
      2. Psychological strategies (e.g., distraction, relaxation techniques, cognitive-behavioral strategies, stress management, patient and family education, and counselling)
      3. Health promotion and self-management
      4. Knowledge of alternative pain-management strategies; for example, neurostimulation (transcutaneous nerve stimulation [TENS], acupuncture, epidural stimulation, brain and spinal cord stimulation, neuroablative strategies (neurolytic nerve blocks, neurosurgical techniques), and palliative radiotherapy (cancer pain)
    3. Interprofessional pain management
      1. Importance of interprofessional teams in pain management
      2. Unique contribution of nursing
      3. Patient and family members as integral members of the pain management team
      4. Patient and family education
      5. Integration and coordination of care including discharge planning, transitions of care
  4. Clinical Conditions
    1. Acute pain associated with trauma, surgery, or acute medical conditions
    2. Pain conditions in palliative care and at end of life, including hospice, home care, and long-term care
    3. Common chronic pain conditions
      1. Low back pain
      2. Arthritis
      3. Headache
      4. Cancer pain
      5. Neuropathic pain conditions
      6. Fibromyalgia

References

Professional standards and clinical guidelines

Association of Paediatric Anaesthetists (2012) Good practice in postoperative and procedural pain management, 2nd edition. Pediatric Anesthesia, 22: 1–79.

Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine (2015) Acute Pain Management: Scientific Evidence, 4th edn. Melbourne: Australian and New Zealand College of Anaesthetists.

Chou, R., Gordon, D.B., de Leon-Casasola, O.A., Rosenberg, J.M.,Bickler, S., Brennan, T., Carter, T., Cassidy, C.L., Hall Chittenden, Degenhardt, E.E., Griffith, S., Manworren, R., McCarberg, B.,  Montgomery, R., Murphy, J., Perkal, M.F., Suresh, S., Sluka, K., Strassels, S., Thirlby, R., Viscusi, E., Gary A. Walco, G.A., Warner, L., Weisman, S.J. and Wu, C.L. (2016) Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council, The Journal of Pain, 17(2): 131-157.

Czarnecki, M. L. & Turner, H. N., (Eds.). (2018). Core Curriculum for Pain Management Nursing, 3rd edition. St. Louis, MO: Elsevier.

Qaseem, A., Wilt, T. J., McLean, R. M., and Forciea, M. A. (2017) Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain, Annals of Internal Medicine, 166(7): 514-530.

Royal College of Nursing (2015) RCN Pain Knowledge and Skills Framework for the

Nursing Team, London: RCN.

Competency content

Fishman, S.M., Young, H.M., Arwood, E.L., Chou, R., Herr, K., Murinson, B.B., Watt-Watson, J., Carr, D.B., Gordon, D.B., Stevens, B.J., Bakerjian, D., Ballantyne, J.C., Courtenay, M., Djukic, M., Koebner, I.J., Mongoven, J.M., Paice, J.A., Prasad, R., Singh, N., Sluka, K.A., St. Marie, B. and Strassels, S.A. (2013) Core Competencies for Pain Management: Results of an Interprofessional Consensus Summit, Pain Medicine, 14: 971–981.

Herr, K., St. Marie, B., Gordon, D.B., Paice, J.A., Judy Watt-Watson, J., Stevens, B.J., Bakerjian, D. and Young, H.M. (2015) Interprofessional Consensus of Core Competencies for Prelicensure Education in Pain Management: Curriculum Application for Nursing, Journal of Nursing Education, 54(6): 317-328.

Reviews – Pain Conditions

Booker, S. & Herr, K. (2016).  Assessment and measurement of pain in adults in later life. Clinics of Geriatric Medicine, 32 (4), 677-692. 

McAuliffe, L., Brown, D., & Fetherstonhaugh, D. (2012). Pain and dementia: an overview of the literature. International Journal of Older People Nursing, 7(3), 219-226 

Hadjistavropoulos, T., Herr, K., Prkachin, K. M., Craig, K. D., Gibson, S. J., Lukas, A., & Smith, J. H. (2014). Pain assessment in elderly adults with dementia. The Lancet Neurology, 13(12), 1216-1227
Lichtner, V., Dowding, D., Esterhuizen, P., Closs, S. J., Long, A. F., Corbett, A., & Briggs, M. (2014). Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools. BMC Geriatrics, 14(1), 138.

Twycross, A., Forgeron, P. and Williams, A. (2015) Paediatric nurses’ post-operative pain management practices in hospital settings:  A narrative review, International Journal of Nursing Studies. 52(4), 836-863.

Twycross, A., Parker, R., Williams, A. and Gibson, F. (2015) Cancer-related pain and pain management: Sources, prevalence and the experiences of children and parents, Journal of Pediatric Oncology Nursing. 32(6): 369-384.

Other papers

Andrew, R., Derry, S., Taylor, R. S., Straube, S., and Phillips, C. J. (2014) The costs and consequences of adequately managed chronic non‐cancer pain and chronic neuropathic pain, Pain Practice, 14(1): 79-94.

Aronoff, G.M. (2016) What do we know about the pathophysiology of chronic pain? Implications for treatment considerations, Medical Clinics of North America, 100: 31-42.

Gatchel, R. J., McGeary, D. D., McGeary, C. A., and Lippe, B. (2014) Interdisciplinary chronic pain management: past, present, and future, American Psychologist, 69(2): 119-130.

van Den Beuken-van Everdingen, M. H. J., et al. (2016). Update on Prevalence of Pain in Patients with Cancer: Systematic Review and Meta-Analysis. Journal of Pain and Symptom Management, 51(6): 1070-1090.

© Copyright 2018 International Association for the Study of Pain. All Rights Reserved. No part of these materials may be reproduced in any form or by any means without the express written permission of the International Association for the Study of Pain. The unauthorized reproduction or distribution of these copyrighted materials is illegal and may result in civil or criminal penalties under the U.S. Copyright Act and applicable copyright laws.