Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Management of Pain

• The plan of care must incorporate the person’s pain management goals and effectively prevent and manage the person’s pain while minimizing the adverse effects from pharmacological interventions.

• If multimodal analgesic approach is used and the person has a personal or family history of substance abuse (misuse or aberrant drug-related behaviours) they should also be assessed for opioid risk when opioids are introduced as part of the pain management strategy Opioid Risk Tool – Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain – Part B

• Non pharmacological (physical and psychological interventions must be considered for effectiveness and potential for interactions with pharmacological interventions. Refer to the National Centre for Complementary and Alternative Medicine (NCCAM) for up- to date information on use of non-pharmacological interventions at

• Nurses must use pain management strategies appropriate for children based on their age and development stage (Link to Appendix N pg 96-99).

• Nurses must monitor and re-evaluate the person’s response to the pain management interventions. Repeated assessment and evaluation should be done with the same tool.

• The frequency of reassessment may vary but should be determined by:
o Presence of pain,
o Pain intensity,
o Stability of the person’s medical condition,
o Type of pain; and
o Practice setting.

• Re-assessment findings should be documented and communicated to the interprofessional team for follow-up actions and for any required changes to the pain management plan of care.