Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 30 Pain Assessment and Management and Management In Pediatrics

2 Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Pain Assessment  Four types of measures to assess child’s pain  Behavioral infant nonverbal scales  Physiologic indicators have limitations r/t source of pain  Self-report greater than 4yo yet often will deny  Multidimensional

3 Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Full, robust crying of preterm infant after heel stick.

4 Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. AGE Appropriate Pain Management Nonpharmacologic management research shows they decrease pain preceptors Infant or Developmental Delay Infant or Developmental Delay  Containment and swaddling  Nonnutritive sucking  Kangaroo care Administration of sucrose has demonstrated pain relief in infants

5 Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Nurse programming a patient-controlled analgesia pump to administer analgesic. CHILDREN Distraction PLAY PLAY PLAY Relaxation Guided imagery

6 Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Pain Management Complementary pain medicine  Manipulative treatments  Energy based  Mind-body techniques  Alternative medical systems

7 Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Pain Management Pharmacologic  Nonopioids such as acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs) are suitable for mild to moderate pain  Opioids are needed for moderate to severe pain  Coanalgesics or adjuvant analgesia  Patient-controlled analgesia PCA Most common post op IV medication Morphine Most common post op IV medication Morphine Adverse side effects (respiratory depression) administer Narcan Adverse side effects (respiratory depression) administer Narcan  Epidural analgesia  Topical EMLA 1 hour before procedure or Refrigerant spray immediate Refrigerant spray immediate

8 Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Key Points  Assessment of pain in children continues to be complex and challenging  Behavioral assessment is useful for measuring pain in infants and preverbal children  Physiologic measures are not able to distinguish between physical response to pain and other forms of stress

9 Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Key Points—cont’d  Number of pain measures available for use in children has increased dramatically  Important components include onset of pain; duration, pattern, effectiveness of treatment; factors that aggravate; complications; mood; and family  Administration of sucrose has demonstrated pain relief in infants

10 Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Key Points—cont’d  Atraumatic care can be provided with use of EMLA and LMX  Nonopiods are suitable for mild-to-moderate pain, opioids for severe pain  Several drugs known as coanalgesics may be used alone or with opioids  Advances in administration of intravenous, epidural, or subcutaneous analgesia is use of patient-controlled analgesia

11 Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Key Points—cont’d  Side effects include respiratory depression and decreased peristalsis  Several harmful effects occur with prolonged and unrelieved pain  Surgery and traumatic injuries generate a catabolic state with increased demands on cardiovascular and respiratory systems