6 Safe and Multimodal Pain Management

Assess pain and set meaningful goals

A useful Pain assessment looks beyond a single pain score. Consider the pain’s cause and pattern, how it affects daily life, and what the patient wants to be able to do. For example, a person with chronic knee pain may want to walk to a nearby shop or sleep more comfortably.

Agree on meaningful goals with the patient, then reassess symptoms and function after treatment. A lower pain score alone does not show whether the plan is meeting the patient’s needs.

Combine treatments to fit the condition

Multimodal care combines appropriate approaches instead of relying on one medicine. Depending on the patient and condition, care may include a nonopioid medicine, an adjuvant medicine, and nonmedicine strategies.

For a mild ankle sprain with no signs of serious injury and no known contraindication to nonopioid treatment, an initial plan may consider an appropriate medicine such as acetaminophen or an NSAID, along with measures such as ice, elevation, rest, or gradual return to activity. Opioids are not needed for many common acute pain conditions; if considered, anticipated benefits should outweigh risks.

Match treatment to the patient

The choice of medicine or other approach depends on the patient and condition. Check for contraindications, other medicines, and possible adverse effects. For burning, electric-like pain from diabetic neuropathy, the care team may discuss condition-appropriate Adjuvant medicines, such as selected antidepressants or anticonvulsants, alongside other care. Patients should not use another person’s prescription or start, stop, or combine medicines without appropriate clinical advice.

Prevent harm from nonopioid medicines

Check active ingredients and product directions, especially when a patient uses more than one product. Acetaminophen is included in many combination products, and taking it from several products at once can lead to an excessive total amount and serious liver injury. When unsure whether products contain the same ingredient, the patient should check labels and ask a pharmacist or clinician.

NSAIDs such as ibuprofen and naproxen can cause serious adverse effects, including gastrointestinal bleeding, kidney problems, and cardiovascular events. Taking two NSAIDs together can increase risk rather than safely improve pain relief.

Review opioid risks and teach safe use

Opioids can cause dangerous sedation and slowed breathing, especially when combined with benzodiazepines, gabapentinoids such as gabapentin, alcohol, or other medicines that depress the central nervous system. Review the full medication and substance-use picture with prescribers or a pharmacist, discuss the increased risks, and make a coordinated, patient-specific safety plan.

Do not advise abrupt medication changes without clinical guidance. Sudden opioid discontinuation can cause harm in a physically dependent patient. Patients should take opioids only as prescribed and should not share them. They should avoid alcohol and check with a clinician or pharmacist before combining opioids with sedating medicines.

Secure storage and disposal

Teach patients to store opioids securely away from children and others and to arrange safe disposal of unused medicine. Clear education should also cover overdose warning signs and whom to contact if pain remains uncontrolled or adverse effects occur.

Prescribe and reassess opioids carefully

When opioid therapy is appropriate for acute pain after considering the patient’s circumstances, safe Opioid prescribing favors an immediate-release medicine when initiating therapy, the lowest effective dose, and a quantity suited to the expected duration of pain severe enough to require it. Provide clear instructions about how to use the medicine, what to avoid, and whom to contact if pain remains uncontrolled or adverse effects occur.

Follow up to reassess benefits, function, and harms. Do not automatically refill without reassessment, advise extra doses beyond the prescription, or begin with an extended-release opioid to prevent all pain. Treatment should be judged by meaningful improvement in pain and function balanced against harms.

A patient with persistent low-back pain may report that an opioid “takes the edge off” while still being unable to sleep or walk comfortably and experiencing constipation and daytime drowsiness. Reassess pain, function, adverse effects, goals, and the overall plan with the patient; consider appropriate nonopioid and nonmedicine options. If opioid changes are appropriate, make them collaboratively and safely rather than escalating automatically or abruptly stopping long-term therapy.

Recognize overdose and reduce risk

Possible signs of Opioid overdose include being unable to awaken, slow or shallow breathing, and bluish lips or nails. If overdose is suspected, give Naloxone if available, call 911, follow emergency-dispatch instructions, and support breathing while waiting for emergency help. Keep the person under observation. Naloxone may wear off before the opioid, so emergency evaluation is still needed.

Discuss overdose prevention and access to naloxone with patients at increased risk. Risk factors described include a previous overdose, concurrent benzodiazepine use, sleep-disordered breathing, substance-use history, and loss of tolerance after a period of reduced opioid use. A history of overdose together with benzodiazepine use particularly merits a risk and prevention discussion, including offering naloxone when indicated.