A patient reports severe pain despite usual analgesia. What is your next step?

• A. Increase the analgesic dose without reassessment.
• B. Do nothing and monitor.
• C. Reassess pain, reassess dosing, consider nonpharmacologic options, and notify the physician if persistent.
• D. Switch to a different pain medication without assessment.

Answer: (C)

When pain remains severe despite usual analgesia, the best next step is to reassess the patient’s pain, reevaluate the dosing, consider nonpharmacologic options, and notify the physician if the pain persists. This approach ensures you verify the current pain level and characteristics, review how the analgesic is being used (dose, timing, route, and potential tolerance or inadequate dosing), and add nonpharmacologic strategies that can help alongside medications. If the pain continues, involving the physician allows for an appropriate adjustment to the plan, which might include changing the analgesic, adding adjuvants, or exploring alternative therapies. Skipping reassessment and simply increasing dose or doing nothing can lead to unnecessary side effects, inadequate relief, or missed underlying issues. Switching medications without assessment can also be inappropriate if the root cause or dosing needs haven’t been evaluated.