A. Original Tools from Contributors to this Issue:
Some of the following tools are downloadable Adobe Acrobat PDF files. If you do not
have Adobe Acrobat Reader and wish to download a free copy you may do so at the
Click on the "Back" button to return to this page after accessing each PDF file.
1. Tools from the Medical College of Wisconsin Palliative Care Program:
©2000 MCW Research Foundation
Permission granted to modify or adopt provided written credit is given to the Medical
College of Wisconsin. Published here with permission.
a. Pain Algorithms
Nursing leaders in Wisconsin Long Term Care Coalition to Improve Pain Management
believed there was a need for an educational tool that could guide nurses through
the analgesic management of pain. Based upon a complete pain assessment, algorithms
were designed to guide nurses through the pharmacological and non-pharmacological
management of pain. To see the algorithms, click on the highlighted terms which follow.
Pain is categorized as Mild (1-3),
Moderate (4-6), or Severe (7-10).
Using the algorithms, the nurse can suggest appropriate interventions for management of
the resident's pain.
b. Guidelines for Analgesic Drug Orders
MCW researchers developed these guidelines to help agencies formulate their own policies
and procedures about the use of analgesics.
2. Tools from Franciscan Woods, Covenant Healthcare:
©2000 Franciscan Woods, Covenant Healthcare
tools are published here with permission.
a. Pain Management Flow Sheet
b. Subacute and Extended Care: Pain Management Guidelines
B. Opioid Converter Online at Cynergy Group founded by Anna and Stuart Du Pen of Du Pen, Inc.:
The Opioid Conversion Calculator is a tool for determining equi-analgesic
doses of opioid drugs. Viewers can input the patient's current regimen,
specify a drug to convert to, and the calculator gives you an equivalent
dose of the new drug. A wide variety of drugs and routes can be specified.
The Calculator is a synthesis of widely-accepted equivalencies, recent
information reported in the literature, clinical experience, and
collaboratively-acquired expert opinions. The site has also tried to
include distilled "best practice" recommendations where possible. Go to the
following page for disclaimer and proceed to the opioid converter:
C. Websites related to this issue's contributors:
End-of-Life Physician Education Resource Center (EPERC)
The purpose of EPERC is to assist physician educators and others in locating high quality,
peer-reviewed training materials. This website supports the identification and dissemination
of information on end-of-life training materials, publications, conferences, and other
opportunities. EPERC is supported by The Robert Wood Johnson Foundation and located at
the Medical College of Wisconsin.
An extensive list of annotated links to pain-related websites can be found at
Mayday PainLink is a virtual community of institutions and practitioners committed to
improving their pain management practices developed by staff at the Center for Applied Ethics
and Professional Practice at EDC in Newton, MA and funded by the Mayday Fund. The site has
both public and members only sections. Members have access to a variety of resources including
technical assistance, e-mail discussions, on-line events and the PainLink Clinician Survey.
Palliative Medicine Program at the Medical College of Wisconsin
This site offers a variety of educational services and information for health care
professionals about pain management and end-of-life care.
Wisconsin Cancer Pain Initiative: A World Health Organization Demonstration
The "Making Pain Management a priority in all health care settings" page includes a
short description of the Medical College of Wisconsin Long-Term Care Pain Management
program featured in this issue of Innovations. The WCPI is a member of the
American Alliance of Cancer Pain Initiatives. Viewers can click on a map to look up
their state's initiative.
D. Other Relevant Websites
American Association of Homes and Services for Aging
The American Association of Homes and Services for the Aging (AAHSA) represents nonprofit
organizations dedicated to providing high-quality health care, housing and services to the
nation's elderly. The website includes information on the organization, its resources and
The American College of Health Care Administrators
A professional society dedicated to advancing the standards of long-term care-from skilled
nursing to assisted living to subacute care.
American Medical Directors Association
This is a national professional organization committed
to the continuous improvement of the quality of patient care by providing
education, advocacy, information, and professional development for medical
directors and other physicians who practice in long-term care. Viewers can enter
"pain management" into search feature to create a list of documents that can be
downloaded, including "CNA RetentionWhat the Medical Director Can Do to Help."
American Pain Society
The mission of the American Pain
Society is to serve people in pain by advancing research, education, treatment
and professional practice. APS is a nonprofit membership society and
welcomes broad participation from all disciplines. Resources include the most
recent information on public policy updates, reference tools, and advances in
American Society of Consultant Pharmacists
Cancer Pain Release
This publication of the World Health Organization Collaborating Center
for Policy & Communications in Cancer Care now posts back issues online. The most recent issue, "Resources for patient education about pain relief in cancer" Vol 13, No. 3-4, 2000 offers an invaluable listing of books, videos, websites, CD-roms, and audiotapes in English, French and Spanish. It is currently only available in hard copy. You may subscribe from the website, however.
Center for Community Change
An organization committed to helping poor people improve their communities
and change policies and institutions that affect their lives by developing
their own strong organizations. This site has specific pages with
resources devoted to "Changing Policies" as well as "Building
Organizations" that may be of particular interest to pain management change
Community-State Partnerships to Improve End-of-Life Care
This page lists policy briefs, which can be downloaded. Issues 5, 6, 7 & 8 focus on
improving long-term care. Issue 5: "Promising Educational Initiatives for Staff, Regulators,
and Families" is of particular interest. Community-State Partnerships is housed at the Midwest
Bioethics Center in Kansas City, Missouri. Myra Christopher, president and CEO of Midwest Bioethics
Center, is national director of the Community-State Partnerships program. A grant program funded by
The Robert Wood Johnson Foundation, Community-State Partnerships to Improve End-of-Life Care, has
awarded $11.25 million to 23 broad-based, multidisciplinary coalitions working to promote policy
change and support for high-quality, comprehensive end-of-life care.
The John A. Hartford Foundation Institute for Geriatric Nursing
This site includes a Best Practices page, which includes a segment called "Try This Series."
Each issue focuses on a particular topic (geriatric depression, pain assessment, cognitive
impairment) reviews a sample tool for assessing this domain. The tools are posted and can be
downloaded; see for example, "Assessing Pain in Older Adults" includes the visual analog scale
and a faces scale for measuring pain intensity.
International Association for the Study of Pain (IASP)
Pain: Clinical Updates the IASP newsletter, is available on the web at
The IASP site also offers extensive links to other resources for dealing with pain at:
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Pain Standards for 2001
National Association Directors of Nursing Administration/Long Term Care
Of particular interest are archived articles from The Director found at
include a three-part series on the evolving role of CNAs, as well as a short piece on
pain: Pain On Hold!
Wong-Baker FACES Pain Rating Scale
Explanation of the development of this popular pain rating scale as well as a version
that can be downloaded and necessary permission forms to complete if users wish to use