Pain Assessment and Management in Children Chapter 30 Pain Assessment and Management in Children All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Assessment of Acute Pain Medical procedures Surgical and orthopedic procedures Medical treatments Injury Infection Exacerbation of disease-related pain All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Assessment of Acute Pain (Cont.) Pain intensity Types of measures to assess child’s pain Behavioral Distress behaviors Physiologic Self-report All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Assessment of Acute Pain (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Assessment of Acute Pain (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Assessment of Acute Pain (Cont.) Behavioral pain measures FLACC CHEOPS TPPPS, PPPRS, PPPM COMFORT FACES OUCHER Numerical rating scale Visual analog scale See Table 30-1 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Assessment of Acute Pain (Cont.) Global judgment of improvement and of satisfaction with treatment Adverse events and symptoms Physical recovery Emotional response All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Assessment of Chronic and Recurrent Pain Pain that persists for 3 months or longer than the expected period of healing Complex regional pain syndrome Chronic daily headache Multidirectional rating scale Physical functioning Emotional functioning Social functioning School functioning All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Assessment of Chronic and Recurrent Pain (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Pain Assessment in Specific Populations Children with communication and cognitive impairment Noncommunicating Children’s Pain Checklist Pain indicators for communicatively impaired children Cultural differences Children with chronic illness and complex pain All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Pain Assessment in Specific Populations (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Pain Management Nonpharmacologic management Distraction Relaxation Guided imagery Cutaneous stimulation Containment and swaddling Nonnutritive sucking Kangaroo care All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Pain Management (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Pain Management (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Pain Management (Cont.) Complementary and alternative medicine Biologically based Manipulative treatments Energy based Mind-body techniques Alternative medical systems All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Pain Management (Cont.) Pharmacologic management Acetaminophen Nonsteroidal anti-inflammatory drugs Opioids Coanalgesia or adjuvant analgesia Patient-controlled analgesia Epidural analgesia All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Pain Management (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Pain Management (Cont.) Pharmacologic management Transmucosal and transdermal analgesia Monitoring side effects Evaluation and effectiveness of pain regimen Consequences of untreated pain Physiologic indicators Behavioral indicators All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Pain Management (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Pain Management (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Common Pain States Pain in primary care Teething Immunizations and vaccinations Common childhood illnesses Painful and invasive procedures Circumcision Open wounds All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Common Pain States (Cont.) Postoperative pain Associated with surgery Combination of medications Burn pain Multiple components Difficult and challenging to control All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Common Pain States (Cont.) Recurrent headaches Tension, dental braces, weakness of eye muscles, sinusitis, epilepsy, sleep apnea, injury Recurrent abdominal pain Common in children Pain associated with sickle cell disease ED visits for opioid treatment All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Common Pain States (Cont.) Cancer Most prevalent symptom is pain Pain and sedation in end-of-life care Comfort can be relief with a combination of opioids and adjuvant analgesics All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Question Which factor is an important consideration in understanding the pain experience in children? A. Children cannot tell where they hurt. B. Children may not admit having pain. C. Narcotics are dangerous drugs for children. D. Children’s sensitivity to pain is less than that of adults. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.