Pain ManagementStudies show EMS & ED personnel fail to recognize andproperly treat pain Oligoanalgesia Undertreatment of pain
Pain ManagementReasons for oligoanalgesia Underestimation of patient’s pain Patient not asked Patient’s level of pain not believed
Pain ManagementHow can we improve...? Make pain the Fifth vital sign Record interventions and reassessment
Assessment Tools: or How do Patients Rate Their Pain...?
Pain ManagementPain travels along nocioceptors from the peripheral to thecentral nervous system to be recognized by the brainModiﬁed as it travels along the pathwaysInterpretation includes psychological, physiological,emotional and behavioral dimensions Cannot infer pain level from degree of damage
Pain ManagementPatient self-reporting is “the most reliable indicator of theexistence and intensity of pain.”
Pain Management Techniques of Three Pain Rating ScalesNumerical rating scale (NRS)(patients verbally requested to rate their pain)Rate your pain from 0 (no pain) to 10 (unbearable pain)Verbal rating scale (VRS)(ﬁve pain levels are indicated in large print on a sheet given to the patient: no pain, mild pain, moderate pain, severe pain, unbearable pain)Choose the adjective best corresponding to your pain level.Visual analog scale (VAS)(A 100-mm rule with a movable cursor: ‘‘no pain’’ is written at the left end of the horizontal line along which the cursor is moved, and‘‘maximal pain’’ at the right end) Move the cursor along the line to indicate the intensity of your pain. The left end of the line represents ‘‘nopain’’ and the right end the most intense pain imaginable, i.e., excruciating and unbearable pain.
Pain ManagementWhat do we need to do...? Make sure using a pain scale that will be reliable (NRS) Children under 8 cannot self-report, need to be vigilant of their behavior to assess pain
Pain ManagementMyth of withholding pain medication for abdominal painMyth of morphine being unsafeMyth of giving treatment delays transport timeConsider analgesia in all patients with isolated extremitytrauma, hip fractures and burns
Pain ManagementRelief of patient’s pain starts with: Use of appropriate wording and distraction away from painful stimuli Keeping parents near children to reduce distress Immobilize fractures, elevate extremities, apply ice packs, pad spinal immobilization devices
Pain ManagementMake pain the ﬁfth Vital SignDon’t judge patientsDon’t infer level of pain based on degree of injuryAssess children under 8 by behaviorDon’t wait until transfer to start alleviating patients pain