Pain management

Question 1

Barriers to pain management

Answer 1

Paramedic
-paramedic may underestimate the pain
-initial low pain score not re-evaluated
Patient
-refusing analgesia
-not saying when pain worsens
-LOC
Organisational
-no new guidelines
-not introducing new drugs in a timely manner

Question 2

Nociception-

Answer 2

the sensation of pain

Question 3

Physiology of pain

Answer 3

-nociceptors- sensory receptors in skin, organs, joints, arteries
-detect burns, cuts, chemical changes and infection

Question 4

4 processes involved in nociception

Answer 4

1. transduction of pain- free nerve endings respond to noxious stimuli
2. transmission of pain- from site to higher centres of brain
3. perception of pain- becomes conscious
4. modulation of pain- by analgesics and anaesthetics produced by pain

Question 5

Pain mechanisms

Answer 5

Somatic
-damage to skin or soft tissues
-localized sharp, aching, throbbing
Visceral
-organ pain, ischaemia, trauma
-more diffuse, gnawing or cramping
Neuropathic
-pain transmitted over damaged nerves
-burning, electric, tingling, migrating eg. amputation, shingles, sciatica

Question 6

Factors effecting pain

Answer 6

-severity of illness/ injury
-gender, culture, enviro, social factors
-anticipation of pain, previous painful experiences
-patients emotions/ character

Question 7

Types of pain

Answer 7

-acute/ helpful pain
-chronic persistent/ unhelpful pain

Question 8

Acute pain

Answer 8

-sudden, can last a few weeks
-causes: trauma, infection, ischaemia
-may result in withdrawal reflex
-triggers sympathetic response- increased HR, BP

Question 9

Chronic persistent pain

Answer 9

-longer than 3 mnths, may come and go
-patients may experience a breakthrough despite following their pain management plan
-high cost, severely affect normal life for patient and family

Question 10

Assessing pain

Answer 10

-use pain assessment tool eg. OLDCARTS
-numerical rating scale- 0-10 10 being worst pain imaginable
-look for any non-verbal signs eg. grimacing

Question 11

Non pharmacological methods of pain management

Answer 11

Physical methods
-splinting of fractures
-cooling burns
-care when moving or handling
-sympathetic and appropriate driving
Psychological methods
-reassurance
-explanation
-distraction techniques eg. conversation and breathing exercises

Question 12

Pharmacological methods of pain management

Answer 12

Analgesia
-IV paracetamol
-oral paracetamol and ibuprofen
-entonox
-oral/IV morphine
-ondansetron (prevents nausea)
-medications carried by air ambulance/ HART

Question 13

Analgesic ladder

Answer 13

Step 1
-non opioid analgesics eg. paracetamol
Step 2
-opioid for mild to moderate pain plus step one eg. codeine, oral morphine
Step 3
-opioid for moderate to severe pain plus step one eg. morphine fentanyl

Question 14

Non pharmacological methods of pain management in infants/ toddlers

Answer 14

Infants
-swaddling/ snuggling with parents
-dummy
-distraction
-reassurance
Toddlers
-distraction
-snuggling with parents
-explanation

Question 15

Assessing pain of the older adult with cognitive impairment

Answer 15

-use abbey pain scale
-measures pain in adults with dementia or cognitive impairment which leaves them unable to verbalise
-6 questions and score them then total the scores