LEARNING OUTCOME AND OBJECTIVES:  Upon completion of this course, you will better understand the experience of pain, appropriate assessment and interventions for pain, and issues regarding opioid use. Specific learning objectives to address potential knowledge gaps include:

• Explain the experience and physiology of pain.
• Outline the elements of a comprehensive pain assessment.
• Describe pharmacologic and nonpharmacologic interventions and self-management strategies.
• Discuss the roles and guidelines for prescribers, nursing, occupational therapy, and physical therapy in pain management.
• Discuss the issues of opioid misuse, abuse, and diversion and drug-seeking behaviors.

Introduction

The word pain comes from the Greek (poiné) and Latin (poena) words for punishment or penalty. In the time of Aristotle and other Greek philosophers, pain was believed to be visited on a person from external sources, in particular, the gods. During the Renaissance, pain was believed to arise from an internal mechanical process, and this theory of pain persisted well into the twentieth century.

Modern pain research began in the 1960s, and in recent decades, there has been a change in the perception of pain that has profoundly influenced scientific and medical pain research and treatment. Pain is no longer viewed as a symptom but rather a disease in and of itself. Its occurrence, severity, duration, response to treatment, and disabling consequences vary from person to person. Like other diseases, pain is more than a biological phenomenon; it has profound emotional and cognitive effects.

In 2010, the Council of the International Association for the Study of Pain (IASP) issued the Declaration of Montreal, which asserts that “withholding of pain treatment is profoundly wrong, leading to unnecessary suffering which is harmful.” The Declaration further asserts:

• Article 1. The right of all people to have access to pain management without discrimination
• Article 2. The right of people in pain to acknowledgment of their pain and to be informed about how it can be assessed and managed
• Article 3. The right of all people with pain to have access to appropriate assessment and treatment of the pain by adequately trained healthcare professionals
  (IASP, 2021a)

To meet this obligation, effective management of pain requires an in-depth knowledge of the complexity of the pain experience, enhanced assessment skills, treatment modalities currently available, and policies that affect how these modalities may be utilized.