# An 82-year-old client with chronic osteoarthritis reports persistent pain rated 7/10 despite taking acetaminophen. The client is concerned about becoming addicted to stronger pain medications. What is the most appropriate nursing intervention?

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## 문제

An 82-year-old client with chronic osteoarthritis reports persistent pain rated 7/10 despite taking acetaminophen. The client is concerned about becoming addicted to stronger pain medications. What is the most appropriate nursing intervention?

## 보기

1. Reassure the client that addiction rarely occurs with proper medical supervision and immediately request a prescription for opioids.
2. Provide education about multimodal pain management approaches including non-pharmacological interventions. **✔ 정답**
3. Suggest the client increase the acetaminophen dosage to the maximum daily limit before considering other options.
4. Recommend that the client accept the current pain level as a normal part of aging and focus on adaptive strategies.

**정답: 2**

## 해설

Educating about multimodal pain management addresses addiction concerns while ensuring effective pain relief. Other options either ignore pain, risk overdose, or dismiss valid fears.

## 심화 해설

Understanding the Client's Concern

The client’s fear of addiction is a significant barrier to effective pain management. While this fear is common, the immediate goal is not to introduce stronger opioids but to address the knowledge gap regarding comprehensive pain control. The client’s pain is rated 7/10, which indicates moderate-to-severe pain that is not adequately managed by the current regimen of acetaminophen alone.

Why Multimodal Education is the Priority

The most appropriate intervention is to provide education about multimodal pain management. This approach directly responds to the client’s concern by offering alternatives to simply escalating to stronger medications. Multimodal management combines pharmacological and non-pharmacological strategies to achieve better pain relief with lower doses of any single agent, thereby reducing the risk of side effects and addressing the psychological fear of addiction [2]. The evidence underscores that chronic pain in older adults is frequently overtreated with passive pharmacological approaches, despite clinical guidelines recommending active strategies that include education and exercise [2].

Analysis of Incorrect Options

- Option 1: Reassuring the client about addiction and immediately requesting opioids dismisses the client’s valid concern and jumps to a pharmacological escalation without exploring other evidence-based options. While opioid use disorder is less common with proper supervision, the priority is to first offer a broader, patient-centered plan that respects the client’s autonomy and fear .

- Option 3: Suggesting the client increase acetaminophen to the maximum daily limit is unsafe advice without a complete assessment of the client’s current total daily intake, liver function, and other medications. It also fails to address the core issue that the current monotherapy is ineffective and that the client is seeking alternative solutions.

- Option 4: Recommending the client accept a 7/10 pain level as a normal part of aging is a misconception and constitutes inadequate care. Chronic pain is a highly disabling condition that should be actively managed, not normalized, as it significantly impacts functional status and quality of life in older adults .

Integrating Evidence into Practice

The rationale for this intervention is strongly supported by current research on geriatric pain. A randomized controlled trial protocol specifically aims to evaluate the efficacy of combining Pain Neuroscience Education (PNE) with exercise in older adults, highlighting that education is a critical, active component of care that can change a patient’s understanding of their pain and reduce reliance on passive treatments [2]. By educating the client on multimodal strategies, the nurse empowers the client to participate in a plan that might include physical activity, which is a key factor in maintaining functional fitness and managing pain in hospitalized older adults . This approach aligns with the broader healthcare goal of providing satisfactory, patient-centered care for the chronically ill, which involves understanding the patient’s perspective and offering comprehensive management strategies beyond medication alone .References (research sources)

- [2]Efficacy of Pain Neuroscience Education Combined with Exercise in Older Adults with Chronic Pain: Study Protocol for a Randomized Controlled Trial.RCT/clinical trialTorres-Alonso J, Polo-Ferrero L, Hernández-Rubia S, Sánchez-Sánchez MC, Puente-González AS, Sáez-Gutiérrez S, Méndez-Sánchez R, Barbero-Iglesias FJ. (2026) · DOI: 10.3390/jcm15103696

## 임상 시나리오

Geriatric Pain Education PriorityAddressing fear of addiction with multimodal options
When an older adult with chronic osteoarthritis reports moderate-to-severe pain (7/10) unrelieved by acetaminophen and voices fear of addiction, the priority is education on multimodal pain management. This validates their concern while introducing non-pharmacological strategies (e.g., physical therapy, heat/cold) alongside medication options, avoiding immediate opioid escalation.

Multimodal approaches combine treatments to achieve better relief with lower individual drug doses, directly addressing the psychological barrier of addiction fear. Clinical guidelines emphasize active strategies over passive pharmacotherapy for chronic pain in this population.

CautionNever dismiss pain as a normal part of aging, and do not recommend self-escalation of acetaminophen to the maximum dose without a comprehensive assessment. Unmanaged pain rated 7/10 requires intervention, not resignation.

## 핵심 개념

- **Multimodal Pain Management** — An approach combining pharmacological and non-pharmacological interventions to optimize pain relief while minimizing reliance on any single therapy.
- **Acetaminophen** — A first-line analgesic for mild-to-moderate pain, particularly in older adults, with a defined maximum daily limit to prevent hepatotoxicity.
- **Non-pharmacological Interventions** — Strategies such as physical therapy, heat/cold application, cognitive behavioral therapy, and exercise used to manage pain without medication.
- **Opioid Use Disorder** — A problematic pattern of opioid use leading to clinically significant impairment, a key fear driving patient reluctance toward stronger analgesics.
- **Chronic Osteoarthritis** — A degenerative joint disease causing persistent pain and stiffness, commonly managed with a combination of lifestyle changes and analgesics.

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