Pain Management and Conscious Sedation for the Pediatric Patient

1996 ◽  
Vol 9 (1) ◽  
pp. 57-74 ◽  
Author(s):  
Cathy Y. Poon
Keyword(s):  
Pain Management ◽  
Health Care Providers ◽  
Pain Assessment ◽  
Clinical Condition ◽  
Conscious Sedation ◽  
Assessment Tools ◽  
Care Providers ◽  
Patient Response ◽  
Pharmacological Agents ◽  
Accepted Practice

Pain management in children was previously ignored primarily because of myths and misconceptions about childhood pain. Undertreatment of pain was once a common and accepted practice. However, in recent years, with increased knowledge and understanding coupled with improved pain assessment tools, health care providers are more conscious about providing adequate and safe analgesia to children. Because of the differences in patient response to various pharmacological agents, it is important to understand the pharmacokinetic and pharmacodynamic differences of the various agents. Choices of pain management should be individualized, and adjustments should be made based on the patient's clinical condition. Conscious sedation before diagnostic and therapeutic procedures should be approached with caution. Deaths and complications related to conscious sedation therapy have prompted the development of guidelines for safer and more effective pharmacological interventions. The recently published guidelines include recommendations for skilled personnel, continuous monitoring, appropriate use of drugs, and ability to manage unforeseen complications. Selection of the most appropriate sedatives should take into consideration the type of procedure, the patient's clinical condition, and the desired level and duration of consciousness. Similar to pain management, individualization is crucial. This article will discuss the principles of pain management and conscious sedation in children. Facts and scientific findings will be presented to discredit the myths and misconceptions often associated with pediatric pain. Various pain assessment tools will be summarized. The newly published sedation guidelines set forth by the American Academy of Pediatrics Committee on Drugs will be briefly discussed. Furthermore, commonly used agents will be reviewed. Copyright © 1996 by W.B. Saunders Company

scholarly journals Plain Language Summary: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

2021 ◽  
Vol 164 (4) ◽  
pp. 704-711
Author(s):  
Samantha Anne ◽  
Sandra A. Finestone ◽  
Allison Paisley ◽  
Taskin M. Monjur
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Clinical Practice ◽  
Pain Management ◽  
Health Care Providers ◽  
Clinical Practice Guideline ◽  
Shared Decision ◽  
Care Providers ◽  
Plain Language ◽  
Opioid Prescribing

This plain language summary explains pain management and careful use of opioids after common otolaryngology operations. The summary applies to patients of any age who need treatment for pain within 30 days after having a common otolaryngologic operation (having to do with the ear, nose, or throat). It is based on the 2021 “Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations.” This guideline uses available research to best advise health care providers, and it includes recommendations that are explained in this summary. Recommendations may not apply to every patient but can be used to facilitate shared decision making between patients and their health care providers.

scholarly journals Nurses’ knowledge and practices related to pain assessment in critically ill patients in a selected private hospital in Bangladesh

2018 ◽  
Vol 5 (10) ◽  
pp. 4219 ◽  
Author(s):  
Sipra Mondol ◽  
Faisal Muhammad ◽  
A. B. M. Alauddin Chowdhury
Keyword(s):  
Critically Ill ◽  
Health Care Providers ◽  
Pain Assessment ◽  
Subjective Experience ◽  
Sampling Technique ◽  
Care Providers ◽  
Cross Sectional ◽  
Management Interventions ◽  
The Mean ◽  
Nurses Knowledge

Background: Most of the time pain is difficult to assess and manage because of being inherently a subjective experience influenced by multiple factors. The perception and tolerance of pain may vary because of different psychological and social influences of the patient. Therefore it is important for health care providers to assess the pain so that individualized management interventions can be provided. This study was aimed to assess the nurses’ knowledge and practices related to pain assessment in critically ill patients.Methods: A descriptive cross-sectional study was carried out among 200 registered nurses working at different ICU in Square Hospital. The study was conducted within April to August 2017. A non-probability purposive sampling technique was used. The data was collected using pre-tested self-administered semi-structured questionnaire and it was analysed using SPSS 22.0 version.Results: About 81% of the respondents were in the age group 22-32 years and the mean age of the respondents was 27.74±12.06 years. About 79.0% of the respondents were female and 59.5% of the respondents had diploma in nursing. The mean monthly income of the respondents’ was 19450.5 taka. The majority (59.5%) of the respondents had less than 2 years’ service experience. About 85.5% of the respondents said it is important to assess the pain and need for analgesia before, during, and after wound care.Conclusions: Our findings reported that the nurses were reasonably knowledgeable about the principles of pain assessment. More than four-fifths of the respondents had adequate knowledge about pain assessment.

scholarly journals Utilization of Non-Pharmacological Methods and the Perceived Barriers for Adult Postoperative Pain Management by the Nurses at Selected National Hospitals in Asmara, Eritrea

2020 ◽  
Author(s):  
Betiel Yihdego Kidanemariam ◽  
Traudl Elsholz ◽  
Laban L. Simel ◽  
Eyasu H. Tesfamariam ◽  
Yonatan Mehari Andemeskel
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Health Care Providers ◽  
Work Experience ◽  
Statistical Significance ◽  
Demographic Data ◽  
Postoperative Pain Management ◽  
Perceived Barriers ◽  
Care Providers ◽  
Cross Sectional

Abstract Background: Pharmacological methods are widely used for postoperative pain management however, poorly controlled pain continues to pose a significant challenge. Non pharmacological methods could contribute to the unresolved postoperative pain management in assisting nurses’ routine care and reducing the need for medication. This study aimed to assess nurses’ utilization of non-pharmacological methods in postoperative pain and the perceived barriers for their implementation at the National Hospitals.Methods: This was a descriptive cross sectional study conducted among 154 nurses working at the National Referral Hospitals and Sembel Private Hospital. A standardized five-point Likert-scale questionnaire which assesses nurses' utilization of selected non-pharmacological methods and the perceived barriers for the implementation was used to collect data. Descriptive statistics for the demographic data, independent samples t-test, one way ANOVA and factorial ANOVA were used to analyze the data. Statistical significance level was set at P < 0.05.Results: The study found out that emotional support (45.5%), helping with daily activities (67.5%) and creating a comfortable environment (61%) were mostly used while, cognitive-behavioral (5.9%) and physical methods (5.8%) were hardly used. The results also showed that, characteristics such as, age (p=0.013), level of education (p=0.012), work experience (p=0.001) and place of work (p=0.001), were significantly related to the use of non-pharmacological methods at bivariate level. However, hospitals were the only determinants of the non-pharmacological methods at multivariable level with a statistical significance of (p<0.001). On the perceived barriers; heavy work load (87.7%), shortage of time (84.4%), limited resources (82.5%), deficit in the guidelines for pain management (77.3%), patient’s uncooperative behavior (57.1%), language difference (64.4%), nurse’s lack of knowledge (50%) and experience (40.3%) were identified.Conclusion: The use of non-pharmacological methods in the studied hospitals varied greatly on the knowledge and experience of the nurses. Therefore, it is recommended that exposure and training for all health care providers at all level is a paramount importance in order to appreciate the benefits of non-pharmacological methods applicable to postoperative pain management. This could be achieved through on job training, seminars, scientific conferences and other brainstorming forums.

2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats

2021 ◽  
Vol 24 (1) ◽  
pp. 4-30
Author(s):  
Paulo V Steagall ◽  
Sheilah Robertson ◽  
Bradley Simon ◽  
Leon N Warne ◽  
Yael Shilo-Benjamini ◽  
...  
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Multimodal Analgesia ◽  
Evidence Base ◽  
Pharmacological Therapy ◽  
Assessment Tools ◽  
Mental Wellbeing ◽  
Team Approach ◽  
Analgesic Drugs

Practical relevance: Increases in cat ownership worldwide mean more cats are requiring veterinary care. Illness, trauma and surgery can result in acute pain, and effective management of pain is required for optimal feline welfare (ie, physical health and mental wellbeing). Validated pain assessment tools are available and pain management plans for the individual patient should incorporate pharmacological and non-pharmacological therapy. Preventive and multimodal analgesia, including local anaesthesia, are important principles of pain management, and the choice of analgesic drugs should take into account the type, severity and duration of pain, presence of comorbidities and avoidance of adverse effects. Nursing care, environmental modifications and cat friendly handling are likewise pivotal to the pain management plan, as is a team approach, involving the cat carer. Clinical challenges: Pain has traditionally been under-recognised in cats. Pain assessment tools are not widely implemented, and signs of pain in this species may be subtle. The unique challenges of feline metabolism and comorbidities may lead to undertreatment of pain and the development of peripheral and central sensitisation. Lack of availability or experience with various analgesic drugs may compromise effective pain management. Evidence base: These Guidelines have been created by a panel of experts and the International Society of Feline Medicine (ISFM) based on the available literature and the authors’ experience. They are aimed at general practitioners to assist in the assessment, prevention and management of acute pain in feline patients, and to provide a practical guide to selection and dosing of effective analgesic agents.

Tools, Time, Training, and Team—Military Primary Care Providers’ Perspectives on Improving Chronic Pain Assessment and Management

2021 ◽  
Author(s):  
Asha Mathew ◽  
Honor McQuinn ◽  
Diane M Flynn ◽  
Jeffrey C Ransom ◽  
Ardith Z Doorenbos
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Pain Assessment ◽  
Insurance Coverage ◽  
Primary Care Providers ◽  
Stepped Care ◽  
Chronic Pain Management ◽  
Care Providers ◽  
Pain Care

ABSTRACT Introduction Primary care providers are on the front lines of chronic pain management, with many reporting frustration, low confidence, and dissatisfaction in handling the complex issues associated with chronic pain care. Given the importance of their role and reported inadequacies and dissatisfaction in managing this challenging population, it is important to understand the perspectives of primary care providers when considering approaches to chronic pain management. This qualitative descriptive study aimed to comprehensively summarize the provider challenges and suggestions to improve chronic pain care in military primary care settings. Materials and Methods Semi-structured interviews with 12 military primary care providers were conducted in a single U.S. Army medical center. All interviews were audio-recorded and lasted between 30 and 60 minutes. Interview transcripts were analyzed using ATLAS 9.0 software. Narratives were analyzed using a general inductive approach to content analysis. The Framework Method was used to organize the codes and emergent categories. All study procedures were approved by the Institutional Review Board of the University of Washington. Results Four categories captured providers’ challenges and suggestions for improving chronic pain care: (1) tools for comprehensive pain assessment and patient education, (2) time available for each chronic pain appointment, (3) provider training and education, and (4) team-based approach to chronic pain management. Providers suggested use of the Pain Assessment Screening Tool and Outcomes Registry, more time per visit, incorporation of chronic pain care in health sciences curriculum, consistent provider training across the board, insurance coverage for complementary and integrative therapies, patient education, and improved access to interdisciplinary chronic pain care. Conclusions Lack of standardized multifaceted tools, time constraints on chronic pain appointments, inadequate provider education, and limited access to complementary and integrative health therapies are significant provider challenges. Insurance coverage for complementary and integrative health therapies needs to be expanded. The Stepped Care Model of Pain Management is a positive and definite stride toward addressing many of these challenges. Future studies should examine the extent of improvement in guidelines-concordant chronic pain care, patient outcomes, and provider satisfaction following the implementation of the Stepped Care Model of Pain Management in military health settings.

Manage My Pain

2019 ◽  
pp. 642-667
Author(s):  
Aliza Weinrib ◽  
Muhammad Abid Azam ◽  
Vered Valeria Latman ◽  
Tahir Janmohamed ◽  
Hance Clarke ◽  
...  
Keyword(s):  
Health Care ◽  
Pain Management ◽  
General Hospital ◽  
Health Care Providers ◽  
Virtual Community ◽  
User Engagement ◽  
Care Providers ◽  
Management Platform ◽  
Surgical Pain ◽  
Chronic Post Surgical Pain

This chapter describes the Manage My Pain digital pain management platform and its integration into the Transitional Pain Service at Toronto General Hospital. A collaboration between ManagingLife, the developer of Manage My Pain, and the Transitional Pain Service led to the creation of a patient-provider virtual community with the aim of managing complex pain after surgery so as to prevent the transition from acute post-surgical pain to chronic post-surgical pain. User engagement, motivation, and satisfaction are discussed with respect to the needs of (1) people living with pain and (2) health care providers. Challenges in implementation are described, along with new features developed for the digital platform as a result of the partnership between ManagingLife and the Transitional Pain Service.

scholarly journals Pain Management Best Practices from Multispecialty Organizations During the COVID-19 Pandemic and Public Health Crises

Pain Medicine ◽  
2020 ◽  
Vol 21 (7) ◽  
pp. 1331-1346 ◽  
Author(s):  
Steven P Cohen ◽  
Zafeer B Baber ◽  
Asokumar Buvanendran ◽  
Brian C McLean ◽  
Yian Chen ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Health Care Providers ◽  
Risk Mitigation ◽  
Health Administration ◽  
Care Providers ◽  
Health Crisis ◽  
Management Services

Abstract Background It is nearly impossible to overestimate the burden of chronic pain, which is associated with enormous personal and socioeconomic costs. Chronic pain is the leading cause of disability in the world, is associated with multiple psychiatric comorbidities, and has been causally linked to the opioid crisis. Access to pain treatment has been called a fundamental human right by numerous organizations. The current COVID-19 pandemic has strained medical resources, creating a dilemma for physicians charged with the responsibility to limit spread of the contagion and to treat the patients they are entrusted to care for. Methods To address these issues, an expert panel was convened that included pain management experts from the military, Veterans Health Administration, and academia. Endorsement from stakeholder societies was sought upon completion of the document within a one-week period. Results In these guidelines, we provide a framework for pain practitioners and institutions to balance the often-conflicting goals of risk mitigation for health care providers, risk mitigation for patients, conservation of resources, and access to pain management services. Specific issues discussed include general and intervention-specific risk mitigation, patient flow issues and staffing plans, telemedicine options, triaging recommendations, strategies to reduce psychological sequelae in health care providers, and resource utilization. Conclusions The COVID-19 public health crisis has strained health care systems, creating a conundrum for patients, pain medicine practitioners, hospital leaders, and regulatory officials. Although this document provides a framework for pain management services, systems-wide and individual decisions must take into account clinical considerations, regional health conditions, government and hospital directives, resource availability, and the welfare of health care providers.

Acute Pain Management

2018 ◽  
Author(s):  
Nihar Patel
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Treatment Options ◽  
Postoperative Pain Management ◽  
Assessment Tools ◽  
Age Appropriate ◽  
Short And Long Term ◽  
Inflammatory Drugs ◽  
Postoperative Setting

Age-appropriate pain assessment and management is vital in the care of children with acute pain. Pain in children should be routinely and regularly assessed, documented, treated and reassessed with clear documentation. Poor pain management in the acute and postoperative setting can result in both short- and long-term consequences. The most effective analgesia plans are multimodal. This chapter focuses on the variety of treatment options for pain in the acute setting. Topics covered include age-appropriate pain assessment tools for children; the basics of age-appropriate pain management in children; as well as the role of opioids, nonsteroidal anti-inflammatory drugs, and patient-controlled analgesia in acute and postoperative pain management in children.

scholarly journals Objectifying the Assessment of Pain

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0046
Author(s):  
Michael Strauss ◽  
Wendy Strauss
Keyword(s):  
Pain Management ◽  
Health Care Providers ◽  
Scoring System ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Initial Assessment ◽  
Care Providers ◽  
Thought Processes ◽  
Pain Scales ◽  
Activity Scale

Category: Other Introduction/Purpose: Pain is a pervasive problem that accounts for a high percentage of referrals to health care providers including foot and ankle surgeons and is an important factor in narcotic addictions and their related deaths. Unfortunately, the analogue pain scores are determined by subjective (SUB) responses of the patient and fail to utilize objective criteria for making the assessments. In an attempt to resolve the subjectivity/objectivity concerns, we developed a scoring system that uses objective (OBJ) criteria based on three 0-to-10 scales. The measurements include the patients’ requirements for analgesics, how the pain affects their levels of activity and how it affects their thought processes. Methods: Over an 18 month period and as part of a physician pain management group’s initial assessment of their patients, the study group was asked to rate their pain using the three SUB scales (Numerical Rating Scale, Visual Analogue Scale and Verbal Rating Scale) as well as our three OBJ scales. Each of our three OBJ (analgesics, activities and thought processes) scales used precise terms to quantify the numerical value for the scale. For example, the analgesics requirement ranged from no drug (0-points) to requirement for hospitalization for pain management (10-points). The activity scale ranged from no limitations (0-points) to pain noticed only with activity (4-points) to total limitation of activities (10-points). Analogous objective criteria were used for the third scale, how pain affects thought processes. Data analysis included patients’ responses to the objective pain measurements as well as correlations between OBJ and SUB evaluation scoring systems. Results: Data was collected prospectively on 109 patients. The mean scores (summation of the3 SUB pain scales divided by 3 and doing likewise for the OBJ pain scales was significantly higher for the SUB scores (6.4 vs. 4.2, p < 0.001). The lowest correlations between the SUB scores and each OBJ scale was with analgesic use (r = .36 vs. r’s = .53 for the other 2 OBJ scales). In general patients who scored highest on the SUB scores, preferred them to the OBJ measurements. Differences between the scores on the OBJ activity scale versus the OBJ thought processes scale helped distinguish pain of central versus peripheral origins. Ninety percent of patients completed the SUB plus OBJ scoring in less than 3 minutes. Conclusion: Our OBJ Pain Score helped differentiate those patients who magnified their pain symptom from those who did not. Patients with higher scores on the thought processes scale would appear to be best managed by central nervous system acting drugs. Conversely those with higher OBJ activity scores would likely respond to peripheral acting agents such as non-steroidal analgesics, local injections or analgesic patches. In summary, our scoring system moves the evaluation of pain from subjective to objective. This has important ramifications for pain management, analgesic selection and avoidance of narcotic dependency.

Considerations for neonatal and pediatric pain management

2019 ◽  
Vol 76 (19) ◽  
pp. 1511-1520 ◽  
Author(s):  
Pooja Shah ◽  
Anita Siu
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Pediatric Patients ◽  
Safety Data ◽  
Clinical Situation ◽  
Assessment Tools ◽  
Patient Specific ◽  
Pediatric Pain ◽  
Unique Challenge

Abstract Purpose Current literature and clinical practice guidelines on pediatric pain management are reviewed. Summary Acute pain is commonly present in neonatal and pediatric patients due to underlying disease states or procedures. Especially in institutions with limited pediatric pain services, it is imperative to describe the appropriate management of pain and pharmacotherapy options that are effective and safe in pediatric patients. Despite the knowledge of pain being an important aspect in the management of children, barriers exist, leading to suboptimal treatment. Addressing these barriers through education of healthcare practitioners, families, and patients will lead to optimizing the patient pain experience. Tools for pain assessment vary depending on the type of pain, the child’s age and understanding of pain, and the clinical situation. Pharmacotherapy options for pain management in neonates and pediatric patients include opioid and nonopioid agents. Efficacy and safety data on the use of medications for the treatment of pain in pediatric patients is described. The delivery of medication encompasses patient-specific factors and preferences. Strategies for opioid stewardship and management of iatrogenic withdrawal pose a unique challenge in pediatric patients. Conclusion The management of acute pain in neonates and pediatric patients should be a priority for all practitioners caring for these patients. Use of age-appropriate pain assessment tools and understanding of the mechanisms of action and roles in therapy of various nonopioid and opioid therapies can help optimize treatment of pain in neonatal and pediatric patients.

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