Pain Management

Q2.07 – July 2007 Pain Management © Copyright 2007 JSL Communications LLC

Pain Management


Learning ObjectivesCognitive Domain

1. Describe the pathophysiology of pain and different types of pain.

2. Describe the assessment of a patient experiencing pain and use of the OPQRST mnemonic.

3. Identify the various pain scales and how they relate to prehospital assessment.


Learning ObjectivesCognitive Domain

4. Discuss the role of pain management for BLS and ALS in the prehospital setting.

5. Explain the various non-medication treatments for pain and the pharmacological treatment options for pain management.


Learning ObjectivesPsychomotor Domain

1. Demonstrate properly assessment techniques of a patient complaining of pain.

2. Demonstrate pain-relieving techniques using non-medicated methods.

3. Demonstrate use of pain scales with patients of various cognitive abilities.

4. Demonstrate the ability to identify and treat pain with the appropriate analgesic.


Key Vocabulary Acute Agonists Alleviate Analgesia Analgesic Anti-inflammatory Analgesic

Breakthrough pain Chronic pain Cognitive CNS Agents Diaphoresis Distract Empathy Endorphins


Key Vocabulary (continued)

FLACC Behavioral Pain Scale

Infiltration Inflammatory Intricate Motivator Non-opioid

analgesic

Neonate Neonatal Infant

Pain Scale (NIPS) Nociceptors Non-Steroidal Anti-

Inflammatory Drug (NSAID) Opiates

Pain Pain scale


Key Vocabulary (continued)

Palliation Parasympathetic Persistent pain Perception Peripherally Physiologic Provocation Psychological

Receptors Sedation Sensation Sensory neurons Sympathetic Therapeutic Wong-Baker

FACES Pain Scale


What is Pain? Next to respiratory distress, pain is one of

the most common reason’s EMS is requested

Protective mechanism Can come on fast or slowly Limits physical abilities Emotional Cognitive Individual


Effects of Pain Reduce function Tiredness Reduced appetite,

nausea Less sleep,

interrupted sleep Less enjoyment More anxiety Depression

Loss of concentration

Loss of control Less interaction Less sex or

affection Appearance change Burden to family

and friends


How Pain Works

Within nervous system Begins at site of injury/illness Nociceptors and sensory neurons Message is transmitted by nerves Spinal cord Brain Muscles at the site


Pain Categories

Acute Chronic Differentiate acute from chronic


Types of Pain

Somatic Surface somatic pain Deep somatic pain

Visceral Neuropathic Breakthrough pain


Assessment

Pain management: Important aspect of patient care After life-threats are stabilized Begins with an assessment

BSI Scene size-up


Assessment (continued)

Initial assessment Focused history and physical exam SAMPLE History OPQRST Interventions

Non-medication vs. Medicated


Pain Scales

Assessment tool Apply to patients with communication

barriers Available for all ages

Some specifically for infants


Adult Pain Scales

Numerical rating scale

1 2 3 4 5 6 7 8 9 10 No Pain Severe Pain Age 8 and up Uses numbers 1-10 to rate pain

Challenges Cognitive ability Hearing Language barrier


Wong-Baker FACESPain Scale

From Hockenberry MJ, Wilson D, Winkelstein ML: Wong's Essentials of Pediatric Nursing, ed. 7, St. Louis, 2005, p. 1259. Used with permission. Copyright, Mosby.


Adult Pain Scales

Wong-Baker FACES Pain Scale Ages 3 and up 6 faces to rate pain

Simply point Hearing is not a factor Language barriers not a factor Cognitive ability simplified


Pediatric Pain Scales

CRIES pain scale NIPS (Neonatal Infant Pain Scale) FLACC Wong-Baker FACES


Pediatric Pain Scales (continued)

NIPS (Neonatal Infant Pain Scale) Ages 0-1 6 criteria, each assigned a number: 0-2

Facial expression Cry Breathing patterns Arm movement Leg movement State of arousal

Score greater then 3 indicates pain


Pediatric Pain Scales (continued)

FLACC Ages 2 months to 7 years 5 assessment criteria

Assign number 0-2 Face Legs Activity Cry Consolability


Communication Challenges

Loss of hearing Inability to speak Language barrier Inability to read Verbal comprehension Loss of vision Medical conditions


Non-medicationPain Management Non-medicated pain management first Techniques:

Recognition Empathy Communication Distraction Therapeutic touch Breathing exercises Conversation Repositioning Elevating injuries Applying ice packs


Medications

Block pain receptors Classifications

Peripheral acting NSAIDs

Centrally acting Morphine Fentanyl Nitronox


Medications (continued)

Morphine Widely used

Acts within 5-10 minutes Lasts 2-3 hours

Causes respiratory depression, and mild peripheral vasodilation



Fentanyl Use increasing Fewer adverse side-effects Fast acting Short lasting Safe on most patients



Nitronox 50-50 oxygen & nitrous Gas is inhaled Rapidly absorbed & delivered to brain Few side effects

Contraindication Trapped gas


Treatment

Initial assessment Focused history and physical exam

SAMPLE history OPQRST

Stabilize patient Non-medicated pain relief Medicated pain relief Ongoing assessment


Applications

Local protocols for preferred pain medications, c-spine precautions and priority patient status

Recent case review Lessons of Scenario drill


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Pain Management

Health & Medicine

pathophysiology of pain

pain works

effects of pain

assessment pain management

various pain scales

use of pain scales

role of pain management

different types of pain