Background: Opioid misuse and addiction have become a national crisis. New pain management guidelines call for the use of multimodal analgesia to manage acute pain. In hospital settings, a clinical decision aid that emphasizes multimodal analgesia may improve nurses' use of this opioid-sparing strategy.

Purpose: This integrative review was conducted to provide nurses with evidence-based information on the opioid-sparing benefits of multimodal analgesia.

Methods: A literature search was conducted using several electronic databases and Google Scholar. These initial searches yielded 136 articles of interest. Twenty-eight were selected for retrieval and in-depth appraisal; of these, 13 met all inclusion criteria.

Results: Of the 13 reviewed studies, six were randomized controlled trials, six were retrospective cohort or population-based studies, and one was a qualitative study. Overall, the findings provided strong evidence that multimodal analgesia is effective in managing acute pain in surgical patients while reducing opioid requirements. Several studies also found that multimodal analgesia was associated with shorter hospital lengths of stay.

Conclusions: With the appropriate tools and education, nurses can make the transition from traditional opioids to multimodal analgesia strategies. In so doing, they can have a significant positive impact on the opioid epidemic. Hospital leaders must address nursing practice regarding the use of opioids alone versus multimodal analgesia for the management of acute pain. Clinical decision tools such as the Michigan Opioid Safety Score may help nurses adopt new acute pain management guidelines. Further research regarding nursing practice and the opioid epidemic is needed.

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Background: Children with sickle cell disease experience vaso-occlusive crises (VOC) that requires opioid pharmacotherapy. Multimodal analgesic therapy may reduce pain and opioid-induced adverse effects.Objective: The primary objective was to examine the effectiveness of intravenous (IV) acetaminophen in children presenting with pain from VOC. Secondary objectives were to document the safety and opioid-sparing effects of IV acetaminophen during VOC in pediatric patients.Setting: Children's Medical Center, NYU-Winthrop Hospital.Method: This retrospective study had two groups of patients, those who received opioids alone (group O) and those who received acetaminophen with opioids (group OA). Children two to 19 years of age who were admitted to the children's medical center for VOC were eligible for inclusion.Main outcome measure: A reduction in pain by at least 1 out of 10. With every analgesic dose, we documented pain scales and pain scores before and after each dose, the number of doses administered per day, and mg/kg/day. Data were analyzed using the mixed effect model. All opioids administered to patients were converted to morphine equivalents. We documented length of stay and adverse events.Results: We had a total of 46 children: 28 in group O and 18 in group OA. Acetaminophen reduced the pain from VOC by 2.3/10. There were trends in different assessments of opioid-sparing effects, in reducing opioid dosage (-0.5 mg/kg morphine equivalent; P = 0.45), reducing overall morphine equivalent doses (-18.5 mg; P = 0.066), and opioid-related adverse effects.Conclusion: This is the first study to demonstrate the effectiveness of IV acetaminophen in treating VOC pain in children, supporting multimodal analgesic therapy in this setting. Opioid-sparing effects were also encouraging.

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Pour faciliter la compréhension des mécanismes de la douleur et de la souffrance, nous vous présentons plusieurs études scientifiques et essais cliniques. Vous serez amené aussi à mieux comprendre comment certaines approches complémentaires et techniques de relaxation peuvent être efficaces dans la gestion de la douleur.

Cette façon de faire «autrement» répondra ainsi à plusieurs interrogations et vous proposera d'autres choix et stratégies, de même que des exercices applicables dès maintenant.

Ces outils, qui s'adressent à tout le monde, peuvent être utilisés par les intervenants, les professionnels, les éducateurs, les aidants naturels (parents, amis, etc.) et par la personne affectée elle-même.

Dans le soulagement de la douleur et de la souffrance, le suivi médical demeure la pierre angulaire du traitement. C'est donc dans un contexte de complémentarité que s'inscrit cet ouvrage qui a pour but d'apaiser vos malaises et de vous offrir une meilleure qualité de vie.