5. Abnormal findings

Abnormal findings and what they may signal — each warrants Mode B focused documentation and, where parameters are met, intervention and notification:

• Pain above the patient's goal, or new pain or a change in pattern, location, or quality.
• Neuropathic features (burning, shooting, electric) suggesting nerve involvement.
• Functional decline attributable to pain — reduced ambulation, impaired activities of daily living, disrupted sleep, or low mood.
• Analgesic adverse effects — constipation, nausea, sedation, or signs of respiratory depression with opioids.
• Signs of under-treatment (persistent pain limiting function) or over-treatment (excess sedation, slowed respirations).
• Pain accompanied by red-flag features — new severe pain, neurologic deficit, or signs of an acute process.