Pain Management



Pain Management


Suzan Schneeweiss



Introduction



  • Treatment of pain should be priority for all clinicians; pain as fifth vital sign


  • Children often endure unacceptable levels of pain during hospitalization


  • Children generally receive analgesia less frequently than adults in the emergency setting


  • When inadequate analgesia is given, children and neonates often experience more distress with subsequent procedures


Pain Assessment



  • Pain history: location, intensity, quality, duration, frequency, aggravating, and relieving factors


  • Regular assessment based on presence and severity of pain: self-report, behavioral observation, and physiologic measures


  • Self-report is considered “gold standard”:



    • Children can report degree of pain by 3-4 yrs


    • Children > 6 yrs can provide detailed descriptions of pain intensity, quality, and location


Pain Scales


FLACC (Face, Legs, Activity, Cry, Consolability)



  • For infants and children ages 2 months to 7 yrs and cognitively impaired


Pain Word Scale



  • For children ages 3-7 yrs and older, children unable to use numerical rating scale


  • Categories: none, a little, medium, a lot









Table 64.1 FLACC Scale





































CATEGORY

0

1

2


Face

No particular expression or smile

Occasional grimace or frown, withdrawn, disinterested

Frequent to constant quivering chin, clenched jaw


Legs

Normal position or relaxed

Uneasy, restless, tense

Kicking, or legs drawn up


Activity

Lying quietly, normal position, moves easily

Squirming, shifting back and forth, tense

Arching, rigid, or jerking


Cry

No cry (awake or asleep)

Moans or whimpers; occasional complaint

Crying steadily, screams or sobs, frequent complaints


Consolability

Content, relaxed

Reassured by occasional touching, hugging or being talked to, distractable

Difficult to console or comfort


*Each of the five categories is scored from 0-2, which results in a total score of 0-10.


Source: With permission from: Merkel SI, Voepel-Lewis T, Shayevitz JR, Malyvia S. The FLACC; a behavioral scale for scoring postoperative pain in young children. Pediatric Nursing. 1997;23(3):293-297.



Faces Pain Scale-Revised (FPS-R)

For ages 5-12 yrs






Figure 64.1 Faces Pain Scale

Source: With permission from: International Association for the Study of Pain. In: Hicks CL, von Baeyer CL, Spafford P, van Korlaar I, Goodenough B. Faces Pain Scale Revised: toward a common metric in pediatric pain management. Pain. 2001;93:173-183.



Numerical Rating Scale



  • For children > 7 yrs


  • Numerical scales from 0-10 or 0-100


Psychological Aspects of Pain



  • Uncertainty, anxiety, and fear of procedures


  • Expectations of pain to be experienced


  • Previous experiences of pain


  • Parental anxiety


Behavioral Approach to Pain

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Jun 22, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Pain Management

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