St Emlyn’s Lesson Plans
Assessing and treating acute pain
Choose a proportionate analgesic plan, check contraindications and make reassessment part of the prescription.
Medical Students · 45-minute session
For learners
Before: Allow about 13 minutes in total.
When we meet: We will compare an ankle injury with severe traumatic pain, checking previous treatment, contraindications and the response to further analgesia.
For facilitators
Send: the learner preparation link before teaching.
Bring: Fictional medication packets or written ingredient lists, pain/observation chart.
Before the session
If you are attending this session, complete the core preparation below before you come. Allow about 13 minutes in total.
Core preparation
RCEM management of acute pain in adults 2024 · About 10 minutes
Read the summary on printed page 2, assessment and reassessment on page 7, and the paracetamol, NSAID and opioid notes on page 10. Focus on previous doses, individual risks and reassessment; use the local formulary for prescribing during the session.
https://rcem.ac.uk/wp-content/uploads/2024/10/Management_of_Acute_Pain_in_Adults_2024_v1.pdf
Prepare (allow 3 minutes): Write four headings for a medication check before giving more analgesia: drug, dose, time taken and relevant patient risks.
Think about: What do you need to know before offering more analgesia to someone who has already taken painkillers?
Picture the scene
A person with an ankle injury remains in pain after taking paracetamol and ibuprofen at home. The nurse asks what the team can offer next.
By the end of the session
- Assess pain and function while considering the injury or illness causing it.
- Check prior doses, contraindications and route before proposing analgesia.
- Describe how to reassess both benefit and adverse effects.
After the session
- On your next supervised analgesia encounter, follow the patient through reassessment and ask whether the agreed goal was achieved.
Facilitator guide
Send learners the preparation link several days before teaching. Allow about 13 minutes in total.
Before learners arrive
- Bring the actual adult analgesia chart, local BNF access and monitoring policy.
- Check how to obtain regional analgesia support and how students seek prescription review.
Equipment: Fictional medication packets or written ingredient lists, pain/observation chart.
Setup: Pairs propose treatment and a separate pair checks the plan for duplication and a missing reassessment.
If the preparation has not been completed
Replace the five-minute “Prepare together” slot. Use the medication history in case 1 and the local analgesia chart. Spend two minutes filling in drug, dose, time and patient-risk headings, two identifying the missing information, and one stating when and how pain and adverse effects will be reassessed.
Suggested session plan
- 0–5 min — Explore. Ask what ‘already tried painkillers’ does not tell us.
- 5–10 min — Prepare together. Practise the four medication checks.
- 10–32 min — Discuss & Apply. Spend 10 minutes on the ankle and 12 on severe pain and adverse effects.
- 32–40 min — Consolidate. Ask each pair to give an analgesic plan that includes prior doses, relevant risks and a time to reassess benefit and adverse effects.
- 40–45 min — Reflect & Transfer. Ask learners to choose a supervised analgesia encounter they can follow through to reassessment.
Start the discussion
Read the opening scenario together. Give everyone a moment to think, then ask what concerns them and what they need to know next.
Cases and discussion
Use these cases, or invite an anonymised case from the group that addresses the same questions.
The ankle still hurts
A 45-year-old has an acutely painful ankle after sport. They report taking two different over-the-counter products, but are unsure what each contained.
Add this information as the discussion develops:
- The packages reveal that both contained paracetamol. They also take an anticoagulant and have previous ulcer bleeding.
- Pain is improved by support and elevation while the clinician completes the injury assessment.
Ask the group:
- What must be clarified before another prescription?
- How do medication history and comorbidity change the choice?
- Which non-drug measures are useful without delaying assessment?
Discussion notes
Points to draw out:
- Confirm ingredients, dose and timing to avoid accidental duplication; refer uncertain overdose concerns promptly rather than simply adding another dose.
- The supervising prescriber should check renal, gastrointestinal, cardiovascular and bleeding risks and relevant drug interactions before NSAIDs.
- Support, appropriate immobilisation and explanation may help alongside medication. Persistent severe pain or neurovascular concern requires reassessment of the injury.
Common misconceptions:
- Assuming all non-prescription medicines are low risk.
- Selecting a drug solely from a pain-score category.
- Using analgesic failure as proof that a person is exaggerating.
For a more experienced group: Ask a pharmacist how the proposed plan changes with kidney impairment or frailty; avoid making ‘one NSAID is always best’ claims.
Severe pain after a fall
A 25-year-old has severe thigh pain after a motorcycle fall. The limb is splinted; they remain distressed and have had prehospital analgesia.
Add this information as the discussion develops:
- The group suggests waiting for imaging before giving anything else.
- After further supervised opioid treatment, pain improves but the patient becomes drowsier and breathes more slowly.
Ask the group:
- What information do you need before further treatment?
- Why should analgesia proceed alongside assessment?
- How will the team recognise and respond to harm?
Discussion notes
Points to draw out:
- Assess injuries, observations, neurovascular status and previous analgesia. Escalate early for severe pain and suspected major injury.
- Appropriately titrated analgesia does not need to await a definitive diagnosis. Select route, dose and monitoring using the local protocol and patient factors.
- Deteriorating consciousness or ventilation requires immediate reassessment and senior help, including consideration of drug effect and the underlying injury.
- Regional analgesia may be an option with an appropriately trained clinician, consent and monitoring. Procedural training needs separate supervised practice and assessment.
Common misconceptions:
- Treating a fixed weight-based opioid amount as a mandatory minimum.
- Assuming a low pain score means treatment is safe.
- Forgetting to re-examine the limb after treatment.
For a more experienced group: Compare an opioid strategy with a regional block, including expertise, contraindications, monitoring and the patient’s preference.
Important clinical points
- Students propose and discuss prescriptions within their supervision arrangements.
- Do not repeat paracetamol or combination products until total exposure is known.
- Opioid administration requires appropriate monitoring and a response plan for respiratory depression.
Closing the session
Use these questions to check what the group will take away. Go back over any clinical points that remain unclear.
- What belongs in the history before another dose?
- Describe one reason to avoid an NSAID and what you would do instead.
- Write a reassessment instruction that covers more than a pain score.
Key teaching points:
- Treat pain while continuing to assess its cause.
- Check previous doses, patient risks and the appropriate route.
- Reassess pain, function and adverse effects after treatment.
Before leaving, ask each person to choose one action from After the session and say when they will try it. They complete that follow-up in practice, with supervision where needed.
Adapting the discussion
Uncertainty and local practice
No single pain score selects a drug. Route and dose depend on the clinical situation and the patient’s risks.
If the discussion drifts
What are we trying to improve, and when will we check both benefit and harm?
For a more experienced group
Explore why oral treatment may be preferable when feasible and when a regional technique changes the plan.
A 30-minute version
30 minutes: opening 3, checks 5, severe-pain case 14, consolidation 5, reflection 3. Use the ankle only as the opening.
Evidence and guidance
- RCEM acute pain guidance 2024 — Contemporary adult ED assessment and analgesia framework.https://rcem.ac.uk/wp-content/uploads/2024/10/Management_of_Acute_Pain_in_Adults_2024_v1.pdf
- NICE medicines optimisation NG5 — Medication reconciliation and safer use; local BNF remains the prescribing reference.https://www.nice.org.uk/guidance/ng5
Suggested curriculum links
GMC Outcomes for graduates / MLA 2026: Pain; safe prescribing and patient care
The session links assessment, medicine safety and observed response.
Check these links against the learner’s stage and programme. Attendance at a teaching session does not establish competence.
First published 2020-09-22 · Iain Beardsell.