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Pain and Symptom Management

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CE1010 | Contact Hours: 2


The purpose of this program is to inform nurses and health care professionals about acute, sub-acute, and chronic pain and best practice for symptom management. After studying the information presented here, you will be able to:

1. Differentiate between acute and persistent pain.
2. Identify characteristics present in a patient with pain.
3. Discuss how pain impacts a person’s ability to function.
4. Identify appropriate outcome measures to quantify a person’s pain.
5. Describe both non-pharmacological and pharmacological interventions for pain.






Rachel Botkin, PT, MPT


All learners must complete the entire activity and complete the evaluation to receive contact hours.


This nursing continuing professional development activity was approved by the Ohio Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. (OBN-001-91).

In addition to states that accept American Nurses Credentialing Center (ANCC) courses, CE Leaders is an approved provider by the Florida Board of Nursing, and a registered provider with the Arkansas State Board of Nursing, District of Columbia Board of Nursing, Georgia Board of Nursing, Kentucky Board of Nursing, New Mexico Board of Nursing, South Carolina Board of Nursing and West Virginia Board of Registered Nurses (Provider # 50-33450).


No one with the ability to control content of this activity has a relevant financial relationship with an ineligible company.


The International Association for the Study of Pain (IASP) defined pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (1).” More than 1 in 5 adults in America experiences chronic pain which makes it one of the most common chronic conditions and a leading cause of disability (2) and an economic burden of between $560 and $635 billion a year (3). A large part of this cost comes from medical expenses as the individuals with pain “who are managed poorly will bounce around the healthcare system, becoming more and more exasperated and consuming considerable resources” (4). 8% of Americans have “high impact” chronic pain which is associated with reduced quality of life (QOL), limitations in daily functioning including social, vocational, and activities of daily living (ADL), and increased health care costs and utilization (2). Pain is also one of the most common reasons that people seek medical care.

Pain, unlike many other chronic conditions, is affected by a range of biopsychosocial factors such as depression, stress, and amount of self-efficacy. Pain may be present with or without a clear anatomical cause. Health care professionals, including nurses, can expect to treat people with pain in all settings, from hospitals to nursing homes, home health, and primary care offices. Nurses can have a profound effect on a person’s pain through detailed examination, history taking, measurement and intervention.


1. Raja SN, Carr DB, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-1982. doi:10.1097/j.pain.0000000000001939.

2. Yong RJ, Mullins PM, Bhattacharyya N. Prevalence of chronic pain among adults in the United States. Pain. 2022;163(2):e328-e332. doi:10.1097/j.pain.0000000000002291.

3. Gaskin DJ, Richard P. The Economic Costs of Pain in the United States. In: Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011.

4. McQuay H. Help and hope at the bottom of the pile. BMJ : British Medical Journal. 2008;336(7650):954-955. doi:10.1136/bmj.39520.699190.94.

5. Basbaum, A. I., Bautista, D. M., Scherrer, G., & Julius, D. (2009). Cellular and Molecular Mechanisms of Pain. Cell, 139(2), 267–284.

6. Bifulco L, Anderson DR, Blankson ML, et al. Evaluation of a Chronic Pain Screening Program Implemented in Primary Care. JAMA Netw Open. 2021;4(7):e2118495. doi:10.1001/jamanetworkopen.2021.18495.

7. Garra G, Singer AJ, Domingo A, Thode HC Jr. The Wong-Baker pain FACES scale measures pain, not fear. Pediatric emergency care. 2013;29(1):17-20. doi:10.1097/PEC.0b013e31827b2299.

8. Krebs, E.E., Lorenz, K.A., Bair, M.J. et al. Development and Initial Validation of the PEG, a Three-item Scale Assessing Pain Intensity and Interference. J GEN INTERN MED 24, 733–738 (2009).

9. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016;315(15):1624-1645. doi:10.1001/jama.2016.1464.

10. Kotfis K, Zegan-Barańska M, Szydłowski Ł, Żukowski M, Ely EW. Methods of pain assessment in adult intensive care unit patients — Polish version of the CPOT (Critical Care Pain Observation Tool) and BPS (Behavioral Pain Scale). Anaesthesiology Intensive Therapy. 2017;49(1).

11. Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. Journal of the American Medical Directors Association. 2003;4(1):9-15. doi:10.1097/01.JAM.0000043422.31640.F7.

12. Cohen-Mansfield J, Lipson S. The utility of pain assessment for analgesic use in persons with dementia. Pain. 2008;134(1-2):16-23.

13. Sullivan, M. J. L., Martel, M. O., Tripp, D., et al. The relation between catastrophizing and the communication of pain experience. Pain 2006, 122: 282 – 288.

14. Kimble P, Bamford-Wade A. The Journey of Discovering Compassionate Listening. Journal of Holistic Nursing. 2013;31(4):285-290. doi:10.1177/0898010113489376.

15. Check DK, Winger JG, Jones KA, Somers TJ. Predictors of Response to an Evidence-Based Behavioral Cancer Pain Management Intervention: An Exploratory Analysis From a Clinical Trial. Journal of pain and symptom management. 2021;62(2):391-399. doi:10.1016/j.jpainsymman.2020.12.020.

16. SPINE-health. Accessed March 12, 2022.

17. Hernandez-Reif M, Field T, Krasnegor J, Theakston H. Lower back pain is reduced and range of motion increased after massage therapy. The International journal of neuroscience. 2001;106(3-4):131-145. doi:10.3109/00207450109149744.

18. Petrofsky JS, Laymon M, Alshammari F, Khowailed IA, Lee H. Use of low level of continuous heat and Ibuprofen as an adjunct to physical therapy improves pain relief, range of motion and the compliance for home exercise in patients with nonspecific neck pain: A randomized controlled trial. Journal of back and musculoskeletal rehabilitation. 2017;30(4):889-896. doi:10.3233/BMR-160577

19. Nurse Key. Accessed March 12, 2022.

20. Sandvik RK, Olsen BF, Rygh L-J, Moi AL. Pain relief from nonpharmacological interventions in the intensive care unit: A scoping review. Journal of clinical nursing. 2020;29(9-10):1488-1498. doi:10.1111/jocn.15194.

21. Liu M, Tong Y, Chai L, et al. Effects of Auricular Point Acupressure on Pain Relief: A Systematic Review. Pain management nursing : official journal of the American Society of Pain Management Nurses. 2021;22(3):268-280. doi:10.1016/j.pmn.2020.07.007.

22. Coutaux A. Non-pharmacological treatments for pain relief: TENS and acupuncture. Joint bone spine. 2017;84(6):657-661. doi:10.1016/j.jbspin.2017.02.005.

23. Reaza-Alarcón A, Rodríguez-Martín B. Effectiveness of nursing educational interventions in managing post-surgical pain. Systematic review. Investigacion y educacion en enfermeria. 2019;37(2). doi:10.17533/udea.iee.v37n2e10.

24. Anekar AA, Cascella M. WHO Analgesic Ladder. [Updated 2021 May 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:

25. Leung L. From ladder to platform: a new concept for pain management. Journal of Primary Health Care. 2012;4(3):254-258. Accessed March 12, 2022.

26. Cuomo A, Bimonte S, Forte CA, Botti G, Cascella M. Multimodal approaches and tailored therapies for pain management: the trolley analgesic model. J Pain Res. 2019;12:711-714. Published 2019 Feb 19. doi:10.2147/JPR.S178910.

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