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Section J Pain Management

  • Nov 18, 2025
  • 4 min read

Table of Contents

  1. Introduction

  2. The Importance of Accurate Pain Assessment

  3. Pain Scoring Methods

    • Numeric Rating Scale (NRS)

    • Visual Analogue Scale (VAS)

    • Wong–Baker Faces Pain Scale

  4. Using Pain Scores in Clinical Decision-Making

  5. Analgesia Options and Their Clinical Considerations

    • Entonox

    • Oxygen Therapy

    • Opioids (Morphine & Fentanyl)

    • NSAIDs

    • Aspirin

    • Paracetamol

  6. Contraindications, Side Effects, and Safe Practice

  7. Clinical Reflections and Practical Takeaways

  8. Conclusion


1. Introduction


Pain management is a cornerstone of high-quality clinical care. Whether in acute settings, chronic disease contexts, or emergency scenarios, the ability to assess pain accurately and apply safe analgesic strategies can significantly enhance patient outcomes. At Kraken Medical, we recognise the importance of equipping clinicians with strong, evidence-based approaches to pain scoring, pharmacological intervention, and patient-centred analgesia.


This article provides an overview of key pain assessment methods and the safe, effective use of commonly administered analgesics. It brings together clinical knowledge, practical tips, and CPD-aligned reflections to support healthcare professionals working across diverse environments.

2. The Importance of Accurate Pain Assessment


Pain is subjective—what one patient rates as a 10/10 another might tolerate with far less distress. For clinicians, objective and repeatable pain scoring tools help transform this subjective experience into actionable clinical information.


Consistent assessment:

  • Guides treatment decisions

  • Helps evaluate the effectiveness of interventions

  • Supports communication across a healthcare team

  • Enables early recognition of deteriorating conditions


Accurate pain assessment is essential for safe analgesic prescribing and patient-centred care.

3. Pain Scoring Methods


Numeric Rating Scale (NRS)

A simple 0–10 verbal scale, where 0 indicates no pain and 10 represents the worst imaginable pain.Key advantages: quick, repeatable, easy for most adults to understand.


Visual Analogue Scale (VAS)

A 10 cm line anchored with “no pain” at one end and “worst imaginable pain” at the other. Patients mark their pain level on the line, which is then measured.Useful for: more nuanced assessment where precision is required.


Wong–Baker Faces Pain Rating Scale

A series of illustrated faces showing increasing discomfort.

Best for: children, individuals with communication or cognitive impairments, or patients with language barriers.

4. Using Pain Scores in Clinical Decision-Making

Pain scores serve as clinical data points.


They:

  • Provide a baseline before treatment

  • Allow comparison after analgesia to measure effectiveness

  • Support ongoing monitoring, particularly in fluctuating conditions

  • Enhance patient-clinician communication by offering a shared framework


Regular reassessment is essential, as pain often changes over time.

Documenting pain scores accurately ensures continuity of care and allows multi-disciplinary teams to adjust treatment plans safely.

5. Analgesia Options and Their Clinical Considerations


Entonox (50% Nitrous Oxide / 50% Oxygen)

A fast-acting inhalational analgesic commonly used in labour, trauma settings, and minor procedures.


Key Points:

  • Self-administered via a mask—patients control their own analgesia

  • Rapid onset and offset

  • Ideal for short-term pain relief

Contraindications:

  • Pneumothorax

  • Severe chest trauma(as expanding trapped gases can worsen pathology)

Side Effects:

  • Dizziness

  • Nausea

  • Light-headedness


Clinicians must educate patients on appropriate use and observe for adverse reactions.


Oxygen Therapy

While not an analgesic itself, oxygen is essential in managing pain related to hypoxia and respiratory distress.


Uses:

  • Hypoxia

  • Respiratory distress

  • Trauma

  • Critical illness

Monitoring:

  • Continuous SpO₂ measurement

  • Titration to target saturations


Caution:Patients with COPD or chronic CO₂ retention may experience reduced respiratory drive with high-flow oxygen.


Side Effects:

  • Rare cases of oxygen toxicity with prolonged high concentrations


Opioids: Morphine & Fentanyl


Morphine

A potent opioid for severe pain such as post-operative or cancer-related pain.


Key Considerations:

  • Individualised dosing

  • Can cause respiratory depression

  • Contraindicated in head injuries due to increased intracranial pressure

Common Side Effects:

  • Sedation

  • Nausea/vomiting

  • Constipation


Fentanyl

A synthetic opioid with rapid onset and shorter duration.


Benefits:

  • Suitable for acute severe pain

  • Available in multiple formulations

Risks & Cautions:

  • High potency increases risk of respiratory depression

  • Similar contraindications to morphine


NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

Commonly used for musculoskeletal pain, inflammation, and mild-to-moderate discomfort.


Contraindications:

  • Peptic ulcers

  • GI bleeding

  • Renal impairment


Side Effects:

  • Gastric irritation

  • Cardiovascular risk with long-term use


Aspirin

Used for analgesia, anti-inflammatory effects, and (in low doses) cardiovascular protection.


Contraindications:

  • Bleeding disorders

  • Children with viral infections (risk of Reye’s syndrome)


Paracetamol

A safe and effective first-line analgesic for many conditions.


Risks:

  • Hepatotoxicity if overdosed

  • Use with caution in liver disease


Strengths:

  • Well tolerated

  • Useful as part of multimodal pain management

6. Contraindications, Side Effects, and Safe Practice


Across all analgesic classes, clinicians must balance benefit against risk. Safe practice includes:

  • Checking medical history and allergies

  • Understanding pharmacokinetics and interactions

  • Monitoring vital signs

  • Reassessing pain scores after intervention

  • Educating patients about side effects and expected sensations

  • Documenting thoroughly


Safe analgesic use is fundamental to patient safety and clinical excellence.

7. Clinical Reflections and Practical Takeaways


  • Pain is dynamic—regular assessment is essential for responsive care.

  • Objective scoring tools help translate subjective experiences into clinical data.

  • Effective education improves patient engagement with analgesic strategies.

  • Understanding pharmacology (dose, contraindications, side effects) prevents harm.

  • Multimodal analgesia often provides better relief with fewer risks.

  • Documentation ensures that care is consistent, safe, and collaborative.


These principles are crucial across all clinical settings—from emergency response to routine outpatient care.

8. Conclusion


Effective pain management starts with accurate assessment and ends with safe, evidence-based interventions. By understanding pain scoring tools and the appropriate use of analgesic medications, clinicians can significantly enhance patient outcomes and provide compassionate, patient-centred care.

 
 
 

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