The Registered Psychiatric Nurses Association of Saskatchewan believes that Pain Management requires the expertise of health care professionals in every field. We support the client in their choice of complementary alternatives, i.e., TENS, meditation, visualization, et. The goal of the care team in Pain Management is to help improve quality of life.

Attitudes about pain and pain management have changed drastically among health-care professionals and the general public. Decisions regarding pain management must be consistent, and part of a wellplanned and structured routine.

The Registered Psychiatric Nurses Association of Saskatchewan believes that the following principles of Pain Control published in association with the Canadian Cancer Society, 1991 should guide Pain Management regimes:

• the concept of "total pain" is the key to successful pain control.
• assessment of the pain must be thorough and relatively rapid.
• unnecessary delays m treating the pain, especially if it is severe must be avoided.
• the client, family and other care givers must be educated and involved m the pain treatment plan.
• a stepped approach to analgesia that depends on the severity of the pain should be followed.
• consideration should be given to adjuvant therapy at all stages.
• medications should be given orally whenever possible.
• constant pain requires regular administration of analgesics to maintain constant levels of analgesia.
• instructions for a "break-through" dose should be recorded on the physicians orders.
• other symptoms, such as constipation, nausea, and muscle spasm must be treated aggressively.
• be flexible - rigid treatment regimes must be avoided.

Total Pain:The concept of "total pain" relates to the clients experience of pain as it relates to somatic factors as well as the many other factors that affect their psychological state.

Breakthrough Dose: The breakthrough dose is essential to handle pain that "breaks through" because it is either not controlled at all or peaks at particular times for whatever reason. Generally, the frequency of administration of breakthrough doses should be specified as at least hourly.

Stepped Approach: World Health Organization Analgesic Stepped Approach In Cancer Pain (modified after WHO Draft Interim Guidelines Handbook on Relief of Cancer Pain, World Health Organization, Geneva 1984)

Non-Opioids = aspirin, acetaminophen, other NSAIDs
Weak Opioids = codeine, oxycodone
Strong Opioids = morphine, hydromorphone
Adjuvants = steroids, psychotropic drugs, anticonvulsants

1. Librach, S. Lawrence, M.D., F.C.F.P.: The Pain Manual - Principles and Issues in Cancer Pain Management; 1991, Pegasus Healthcare, Canada, pp. 26-29.

Approved by Council
September 1995