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Chapter 35

Chapter 35. Pain Assessment and Management. Pain Assessment. Four types of measures to assess child’s pain Behavioral Physiologic Self-report Multidimensional. Behavioral Pain Measures. FLACC FACES OUCHER Poker chip tool Word-graphic rating scale Numeric scale Visual analog scale

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Chapter 35

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  1. Chapter 35 Pain Assessment and Management

  2. Pain Assessment • Four types of measures to assess child’s pain • Behavioral • Physiologic • Self-report • Multidimensional

  3. Behavioral Pain Measures • FLACC • FACES • OUCHER • Poker chip tool • Word-graphic rating scale • Numeric scale • Visual analog scale • Color tool

  4. Pain Assessment in Specific Populations • Pain in neonates • CRIES, PIPP • Children with communication and cognitive impairment • Noncommunicating Children’s Pain Checklist • Cultural issues in pain assessment • Children with chronic illness and complex pain

  5. Pain Management • Nonpharmacologic management • Distraction • Relaxation • Guided imagery • Containment and swaddling • Nonnutritive sucking • Kangaroo care

  6. Pain Management—cont’d • Complementary pain medicine • Biologically based • Manipulative treatments • Energy based • Mind-body techniques • Alternative medical systems

  7. Pain Management—cont’d • Pharmacologic management • Nonopioids • Opioids • Coanalgesics or adjuvant analgesia • Patient-controlled analgesia • Epidural analgesia

  8. Pain Management—cont’d • Pharmacologic management • Transmucosal and transdermal analgesia • Timing of analgesia • Monitoring side effects • Evaluation and effectiveness of pain regimen

  9. 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

  10. 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

  11. 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

  12. 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

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