9. Pain Management
Pain travels along nocioceptors from the peripheral to the
central nervous system to be recognized by the brain
Modified as it travels along the pathways
Interpretation includes psychological, physiological,
emotional and behavioral dimensions
Cannot infer pain level from degree of damage
12. Pain Management
Techniques of Three Pain Rating Scales
Numerical 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 ‘‘no
pain’’ and the right end the most intense pain imaginable, i.e., excruciating and unbearable pain.
13. Pain Management
What 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
15. Pain Management
Myth of withholding pain medication for abdominal pain
Myth of morphine being unsafe
Myth of giving treatment delays transport time
Consider analgesia in all patients with isolated extremity
trauma, hip fractures and burns
16. Pain Management
Relief 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
17. Pain Management
Make pain the fifth Vital Sign
Don’t judge patients
Don’t infer level of pain based on degree of injury
Assess children under 8 by behavior
Don’t wait until transfer to start alleviating patients pain