Flashcards in Pain Management ✅ Deck (63)
What does good pain management require?
Assessment, communication, planning, and a good knowledge of pharmacology and physiology
Who is pain often under-recognised in?
Children with disability
What is pain defined as?
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
What is pain influenced by?
- Past pain experiences
- Concerns about personal wellbeing or that of others
What is total pain?
The concept that pain always occurs in the context of emotional need, fears, past experiences, and understanding of the pain as well as biological experience
Are all children able to feel pain?
What does assessment of pain in children require?
- Detailed history
- Observation of the child, ideally in a variety of settings
- Consideration of all possible contributing factors
- Discussion with parents
- Use of pain assessment tools
What possible contributing factors need to be considered when assessing pain?
What do pain assessment tools need to be appropriate to?
Age and cognitive ability of the child
What might be a sign of pain in a non-verbal child?
- Crying and changing in vocalisation
- Quietening/becoming withdrawn
- Frowning/grimacing on passive movement
- Increasing seizure or spasm frequency
- Change in feeding pattern
- Hypersensitivity to stimuli
- Change in posture or behaviour, e.g. head banging, rubbing a limb
- Increased flexion or extension
What are the most commonly used types of pain scale?
- ‘Faces’-type tools
- Scales based on observation of behaviour patterns associated with pain in non-verbal children
Give an example of a scale based tool for assessing pain?
The Paediatric Pain Profile
What are Faces-type tools for assessing pain based on?
Likert scale (the agree, neutral, disagree thing)
Who are most ‘faces’-type scales for pain assessment validated in?
Acute pain in cognitively normal children
What are the steps in pain management?
1. Consider and treat specific reversible causes
2. Consider non-pharmacological measures
3. Pharmacological approach
Give 3 specific reversible causes that should be considered in the management of pain?
- Gastro-oesophageal reflux
- Orthopaedic, especially hip dislocation
What non-pharmacological measures should be considered in the management of pain?
- Attention to reversible sources of fear and anxiety
- Counterirritants and distraction techniques
- Behavioural techniques
Give 3 examples of counter-irritants that can be considered in the non-pharmacological management of pain?
- Hot or cold packs
What behavioural techniques can be considered in the non-pharmacological management of pain?
- Cognitive behavioural therapy
- Visualisation or art therapy
What is the WHO pain ladder the basis for?
The rational management of palliative pain
What does the WHO pain ladder express the concept of?
That increases in the intensity of pain should be matched by changes both in the type of analgesic and manner in which they are prescribed
What are the steps in the WHO analgesic ladder?
1. Simple analgesics
2. PRN opioids
3. Regular opioids
When should you move up a step in the WHO analgesic ladder?
When the pain intensity increases and the effect of prescribing on one step becomes inadequate
What is each step on the WHO analgesic ladder characterised by?
- A specific class of analgesic
- A specific approach to dosing (regular vs. PRN)
- Need to consider adjuvants appropriate to the nature of the pain
What is an adjuvant?
A medication or other intervention that is not an analgesic but, used alongside analgesics, its actions can reduce pain in certain specific situations
What is step 1 in the WHO analgesic ladder?
What is step 1 on the WHO analgesic ladder used to treat?
Is step 1 on the WHO analgesic ladder regular or PRN?
What is step 2 on the WHO analgesic ladder?