5. Medication and treatment monitoring

Monitor the pain regimen for effect and, above all, for safety, correlating with the ordered parameters:

• Opioids — dose and schedule against the order, analgesic effect toward the functional goal, and the safety parameters (sedation and respiratory rate) before and after doses; the safety parameters govern whether a dose is held.
• Breakthrough or as-needed opioid — frequency against the ordered limit and whether it is escalating.
• Non-opioid analgesics and adjuvants — acetaminophen (with attention to the daily maximum), anti-inflammatory agents where not contraindicated, and neuropathic-pain adjuvants — for effect and agent-specific adverse effects.
• The bowel regimen — whether it is preventing opioid-induced constipation within the ordered interval (cross-reference Gastrointestinal).
• Naloxone — availability, expiration, and caregiver competence.
• Any transdermal or long-acting formulation — correct application, placement, and disposal, and the added caution these carry.
• Concurrent central-nervous-system depressants — identified and reported for the compounded respiratory-depression risk.