A patient reports a pain level of 3 out of 10 on the numeric rating scale. According to the WHO pain ladder, which initial management strategy is most appropriate for this level of pain?

1. A

   Administering intravenous morphine

2. B

   Prescribing strong opioids like fentanyl

3. C

   Using non-pharmacological therapies and NSAIDs

4. D

   Recommending immediate surgical intervention

Appeared in: HPSSC - 2015

Explanation

• A pain score of 3 on a 1-10 scale is classified as mild pain.
• According to the WHO analgesic ladder, the first step for managing mild pain is to use non-opioid analgesics.
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are a primary example of non-opioid analgesics recommended in Step 1.
• Non-pharmacological therapies are also recommended as an adjuvant at all levels of pain management, making this option the most comprehensive and appropriate choice for mild pain.

Why Other Options Were Wrong

• Option A: Intravenous morphine is a strong opioid, which is indicated for severe pain (7-10/10), corresponding to Step 3 of the WHO ladder.
• Option B: Fentanyl is a potent, strong opioid analgesic. It is reserved for severe pain (7-10/10) as per Step 3 of the WHO ladder.
• Option D: Surgical intervention is not a primary pain management strategy on the analgesic ladder. It is a treatment for the underlying cause of pain, not the symptom itself.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Application of the WHO Analgesic Ladder for Pain Management to guide bedside assessment, documentation, and the next nursing action.
• A core nursing responsibility is accurate pain assessment and advocating for the appropriate level of analgesia. Starting with the lowest effective dose and least invasive option minimizes side effects and risks of tolerance or dependence.
• Nurses must frequently reassess pain after any intervention (pharmacological or non-pharmacological) to evaluate its effectiveness and determine if a change in the care plan is needed.
• What if? If the patient's pain score increased to 5/10 despite receiving an NSAID, the nurse should reassess and anticipate escalating care to Step 2 of the ladder, which involves adding a weak opioid like tramadol or codeine.

How to Approach the Question

• First, identify the key clinical data in the question: the patient's pain score is '3 out of 10'.
• Next, identify the framework you must use: the 'WHO pain ladder'.
• Recall or visualize the WHO pain ladder. Categorize the pain score: 1-3 is mild, 4-6 is moderate, and 7-10 is severe.
• Place the patient's score of 3 into the 'mild' category, which corresponds to Step 1 of the ladder.
• Review the options to find the intervention that matches Step 1. Step 1 recommends non-opioid analgesics (like NSAIDs) and adjuvant therapies.
• Eliminate the options that are for moderate or severe pain (morphine, fentanyl) or are not part of the standard analgesic ladder (surgery).

Concept Tested & Keywords

• Concept Tested: Application of the WHO Analgesic Ladder for Pain Management
• Stem keywords: pain level of 3 out of 10, numeric rating scale, WHO pain ladder, initial management
• Lead-in keywords: most appropriate
• Clinical cues: Pain score of 3/10 indicates mild pain, guiding the choice of initial intervention.
• Negative lead-in flag: false

Question ID

Q3CCG1bZ1lB5AJcl9i6yqc

Copy ID

Reference Book

E6 Medicine Davidson Principles Practice 24e p. 1370-1372

E6 Nursing Vital Signs p. 139-141