Master of Science in Nursing (MSN) Student Scholarship

Date Written

Fall 2014

Document Type


Course Number

NURS 5330

Course Name

Advanced Pathophysiology

Professor’s Name

John D. Chovan, James R. Cacchillo


Therapeutic Modalities, Best Practices

Subject Categories

Medical Pathology | Nursing


Multimodal therapy works best to control postoperative pain safely. Multimodal pain treatment involves the use of two or more classes of analgesics to target different pain mechanisms. Why? Data is present that supports that health care systems are still under treating pain in the postoperative patient. Unrelieved pain has harmful effects to multi ple body systems. There is still a need to provide education to providers, nurses and patients to promote best practice in pain management approaches regarding multimodal therapy. Opiate analgesics still remain the most commonly used treatment for pain following surgery. Using this singular analgesic modality could put patients at risk for hypoxemia, as respiratory depression is the most dangerous of opioid side effects (Hartrick, 2004). In addition, patients can still have uncontrolled pain on this single analgesic regimen for pain management. Evidence points to multimodal therapy consisting of rational combination of analgesics with different underlying mechanisms that help to achieve the greatest pain relief. The use of the multimodal approach allows for lower doses of each drug and therefore has the potential to minimize adverse effects. Maximizing pain relief while preventing gaps in analgesia is the goal to prevention of worsening pain. Using drug therapy to target both inflammatory and neuropathic pain in the setting of postoperative pain can prove to be opioid sparing. Multimodal and preemptive therapies to prevent postoperative pain have improved by recent advances in the understanding of how undertreated acute pain can lead to chronic pain. Also, more attention has been placed on the role of local inflammation occurring at the injured tissue site. This inflammatory process increases the sensitivity of nociceptors. This prompted the adding of non-steroidal anti-inflammatory drugs to preventively control postoperative pain. Blocking pain signals by a variety of methods has improved postoperative pain management and the patient benefits from all these measures (Cornwell, 2013



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