PAEDIATRIC PALLIATIVE CARE PAEDIATRIC PALLIATIVE CARE PAIN MANAGEMENT PAIN MANAGEMENT Lynette Thacker Lynette Thacker Clinical Nurse Specialist Clinical Nurse Specialist Paediatric Palliative Care Paediatric Palliative Care 07773281621 07773281621 Disclaimer: Whilst every effort has been made to ensure that the information in this presentation is accurate and referenced the author does not accept any responsibility for the use by any third parties.
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PAEDIATRIC PALLIATIVE CARE PAIN MANAGEMENT Lynette Thacker Clinical Nurse Specialist Paediatric Palliative Care 07773281621 Disclaimer: Whilst every effort.
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PAEDIATRIC PALLIATIVE CAREPAEDIATRIC PALLIATIVE CARE
0777328162107773281621Disclaimer: Whilst every effort has been made to ensure that the information in this presentation is accurate and referenced the author does not accept any responsibility for the use by any third parties.
Definition of Palliative CareDefinition of Palliative Care
Palliative care is the active, total care of the patient whosedisease is not responsive to curative treatment. Control ofpain, of other symptoms, and of social, psychological andspiritual problems is paramount. Palliative care isinterdisciplinary in its approach and encompasses the patient,the family and the community in its scope. In a sense,palliative care is to offer the most basic concept of care – thatof providing for the needs of the patient wherever he or she iscared for, either at home or in the hospital. Palliative careaffirms life and regards dying as a normal process; it neitherhastens nor postpones death. It sets out to preserve the bestpossible quality of life until death.
(European Association for Palliative Care 1998)
What is Pain What is Pain Pain is an emotion experienced in the brain, it is not like
touch, taste, sight, smell or hearing. Pain can be perceived as a warning of potential damage, but can also be present when no actual harm is being done to the body.
“Pain is what the individual tells us they are experiencing, where it is, when it occurs, what it feels like, what makes it better and when its disappeared.”
It is categorised into:• Acute pain - less than twelve weeks duration and may
serve as a warning of injury and tissue damage, this pain may not necessarily be associated with major or persistent changes in lifestyle or relationships.
• Chronic pain - of more than twelve weeks, which may be persistent or recurrent, is often associated with substantial alterations in behaviour and in relationships.
Definitions of Types of Pain Experienced in Definitions of Types of Pain Experienced in Palliative CarePalliative Care
• Allodynia - Pain due to a stimulus that does not normally provoke pain. For example, stroking the skin lightly with clothes or cotton wool will produce pain.
• Causalgia - Disruption in normal flow of sensory information along nerve to brain, creating a confusion for the brain, which is interpreted as a constant , uniquely disabling pain state which is highly resistant to normal forms of medical therapy.
• Deafferentation pain - Pain that occurs, often after trauma or surgery, presenting as neuropathic pain in an area of numbness or loss of sensation.
• Hyperalgesia - The perception of a painful stimulus as more painful than normal.
• Neuralgia - Pain in the distribution of a nerve or nerves• Neuropathic pain - Is pain initiated or caused by a primary
lesion or dysfunction in the peripheral or central nervous system. For example pain following shingles, or an amputation, or spinal cord trauma.
(The British Pain Society 2006-2007-2008)
TYPES OF PAIN
NOCICEPTIVE
• Organs – heart, liver, pancreas, gut, etc.
• Constant or crampy• Aching• Poorly localized• Referred
Somatic
•bones, joints•connective tissues•Muscles
•Aching, often constant• May be dull or sharp• Often worse with movement• Well localized
Viscera
NEUROPATHIC
Deafferentation Sympathetic Maintained Peripheral
When Do Children Experience PainWhen Do Children Experience Pain
Pains experienced by children with palliativecare conditions are a result of:• Investigations• Treatment• Disease• Disability secondary to the disease
process• Coincidental to the disease. • Both acute and chronic.
Palliative CarePalliative Care Approach To Pain ControlApproach To Pain Control
• Thorough assessment of the pain experience by skilled and knowledgeable professional.
• Assessment of pain includes history, location, intensity or severity, quality (description), duration, pattern, current treatment and response to treatment (pharmacological and non-pharmacological; interventional analgesia), physical examination.
• Discuss with child (if cognitively appropriate) and family the goals of care, hopes, expectations, anticipated course of illness.
• Refer to medical team who may wish to undertake further investigations – X-Ray, CT, MRI, etc. For treatment of reversible causes of pain.
• Ongoing reassessment and review of options, goals, expectations, etc.
How Do We Assess Pain
Choosing a pain assessment tool
Pain Scales
• Use appropriate tool for the child’s age and cognitive development
• Use the same pain scale for the child
Self-report of pain Self-report of pain The ability of children to describe and rate their own painvaries with their age, developmental stage, and health.
Wong-Baker FACES Pain Rating Scale
0 1 2 3 4 5 6 7 8 9 10No Pain Mild Moderate Severe Worst Possible
Numeric Rating Scale
Behavioural Pain ToolsBehavioural Pain ToolsPaediatric Pain ProfileThe Paediatric Pain Profile is a behaviour rating scaledeveloped to assess pain in children with severe motor andlearning disabilities. The tool is envisaged as a parent helddocument, and contains documentation of the child's pain history, baseline, and on-going pain assessments.
Consists of:• Pain history• Current pain problems• Childs behaviour on a good day• Current pain behaviour• Ongoing assessment of pain
Treating PainTreating Pain
The treatment of pain should not beabout just giving medications.