6.0 Pain and Mobility Introduction V2
Learning Objectives
- Identify the classifications and actions of medications related to pain and mobility
- Consider examples of when, how, and to whom pain and mobility medications may be administered
- Identify the side effects and special considerations associated with pain and mobility medication therapy
- Identify considerations and implications of using pain and mobility-related medications across the lifespan
- Consider evidence-based concepts when using the nursing process, clinical reasoning, and decision-making related to medications for pain and mobility
- Consider the impact of opioid analgesics on the overdose crisis and the responsibility of the nurse for client education, naloxone administration, and pain management advocacy
Key Terms
- acute pain
- adjuvant analgesics
- chronic pain
- immune-mediated disease
- misuse
- mobility
- muscle spasticity
- nociceptors
- non-pharmacologic therapy
- opioid withdrawal
- opioid naïve
- opioid tolerance
- physiologic dependence
- pain
- patient controlled analgesia
- prostaglandins
- steady state
- tolerance
- Total Daily Dose (TDD)
- vertigo
Complaints of pain are one of the most common reasons individuals seek out medical care. The pain signal indicates that something in the body is not quite right. Whether it be a headache, a broken bone, labor pain, chest pain, or other condition, pain assessment and treatment is an important part of nurse’s care for their clients.
Definition of Pain:
In 1979, the International Association for the Study of Pain defined pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage (International Association for the Study of Pain [IASP], 2020). They have recently expanded this definition to include the following six notes:
- Pain is always a subjective experience that is influenced to varying degrees by biological, psychological, and social factors.
- Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.
- Through their life experiences, individuals learn the concept of pain.
- A person’s report of an experience as pain should be respected.
- Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being.
- Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain.
From this definition, pain is more than a neural or chemical mechanism but is modulated by many factors that include emotional, psychosocial, behavioural, and past and current experiences. Pain is complex and multifactorial. Every client’s response to pain will be different and nurse’s must be able to adapt their treatment by taking into account these differences. In unit 10.2, we will explore this concept further.
Pain impacts all demographics in Canada. For many people, pain is temporary or acute and serves as a warning sign something is wrong. Acute pain, such as pain experienced following an injury or surgery, typically last less than 4 weeks, and resolves with tissue healing (Province of BC, 2023).
Chronic pain persists greater than 3 months, and can be due to many medical conditions. According to the Canadian Pain Task Force Report, October 2020, it is estimated that 7.63 million, or one in four Canadians aged 15 or older, live with chronic pain. One in five children report pain and mostly report headaches, although all forms can lead to a negative impact on life by contributing to depression, and an impact on mood and sleep. It is reported that 50% of clients with chronic pain have suffered with this pain for over 10 years. The prevalence of pain seems to increase with age, with reports ranging from 65-80% depending on age over 65 (Registered Nurses Association of Ontario [RNAO], 2025). Pain is often hidden and interwoven with other chronic conditions. As such, chronic pain has significant impacts on physical and mental health, family and community life, society and the economy. Pain is often misunderstood, underdiagnosed and poorly treated.
Health Canada released a report in 2021, titled ‘An Action Plan for Pain in Canada’ that lays out particular strategies to improve pain management in Canada. Some of these strategies we will address in this chapter. To effectively assess, manage and prevent pain, nurses will work collaboratively with the health care team, their clients and caregivers.
In this chapter:
- Pain and mobility concepts including the physiology of pain and contributing factors.
- Conditions and diseases of pain
- Medication classifications: non-opioids, opioids, adjuvant, anti-gout and anesthetics.
- Clinical Thinking and Clinical Judgment Learning Activities to consolidate your understanding.
References:
Health Canada (2021). An action plan for pain in Canada. Ministry of Health. ISBN: 978-0-660-38498-6 | Pub.: 210048 report-rapport-2021-eng.pdf
International Association for the Study of Pain [IASP], (2020). IASP announces revised definition of pain. https://www.iasp-pain.org/publications/iasp-news/iasp-announces-revised-definition-of-pain/
Registered Nurses Association of Ontario (RNAO). (2025, February). Pain: Prevention, assessment and management (4th ed.). Toronto (ON): RNAO; 2024. https://rnao.ca/bpg/guidelines/assessment-and-management-pain
The breakdown of a drug molecule via enzymes in the liver (primarily) or intestines (secondarily).
The final stage of pharmacokinetics; process by which the body eliminates waste or excess.
How a medication works at a cellular level within the body.
The dosing window in which the safest and most effective treatment will occur.
When a medication first begins to work and exerts a therapeutic effect.
Stimulation causes increases speed of conduction between SA and AV node.
A measurement of the amount of drug that produces a therapeutic effect compared to the amount of drug that produces a toxic effect.
When the maximum concentration of drug is in the body.
Mimic the effects of the body’s natural SNS stimulation of adrenergic receptors. Also called adrenergic agonists.
Opioid withdrawal occurs when an opioid is discontinued abruptly. Withdrawal symptoms last for a few days and include nausea, anxiety, restlessness, diaphoresis, tachycardia and drug craving.
Opioid naïve refers to a client who has either never had an opioid or who has not received repeated opioid dosing for a 2 to 3 week period.
This is a state of adaptation in which exposure to a drug induces changes that result in a decrease in the drug’s effect over time. It is a known pharmacologic effect of opioids.
physiologic dependence is a physical condition caused by chronic use of a tolerance-forming drug, in which withdrawal symptoms are produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug and / or administration of an antagonist. This can occur with any mu-opioids, GABA agonists or positive allosteric modulators of GABA-a or GABA-b.
Stimulation causes increased force of contraction.
A nearly impenetrable barricade that is built from a tightly woven mesh of capillaries cemented together to protect the brain from potentially dangerous substances such as poisons or viruses.
The length of time that a medication is available within the body and producing its desired therapeutic effect.
steady state is when the rate of drug availability and elimination equal one another.
This is a to the analgesic effects of opioids is relatively uncommon.
total daily dose is the 24 hour total of a drug that is taken for regular and breakthrough doses.
Mimic the effects of the body’s natural SNS stimulation on alpha (α) and beta (β) receptors. Also called sympathomimetics.
