Pain Management Flashcards
Types of Pain (6)
- Acute pain – lasts <6 months
- Chronic pain – lasts >6 months
- Acute on chronic pain
- Somatic Pain – Originating from bones, joints, muscles, skin, or connective tissue
- Neuropathic Pain – Originating from peripheral or central nervous system
- Visceral Pain – Originating from internal organs
Barriers to the Treatment of Pain in Children (6)
The myth that children, especially infants, do not feel pain Or if they do, there is no untoward consequence
Lack of assessment and reassessment for the presence of pain
Misunderstanding of how to conceptualize and quantify a subjective experience such as pain
Lack of knowledge of pain treatment
Notion that addressing pain in children takes too much time
Fear of adverse effects from analgesics
Consequences of Unrelieved Pain (8)
- Rapid, shallow breathing, and inadequate expansion of lungs
- Increased HR and BP
- Increased stress hormones
- Slowing/stasis of gut and urinary systems
- Muscle tension, spasm, and fatigue
- Behavioral disturbances- Fear, Anxiety, Reduced Coping, Developmental regression
- Allodynia – what was not painful before is now painful
- Hyperalgesia – what was painful before is now exponentially painful
Pain Assessment Tools by Age
Toddlers (5)
o Nonverbal cues to indicate pain and can point to area of pain
o Grimacing
o Whimpering, crying
o Grabbing/tugging/holding affected area
o Inactivity, disinterest in usual activities
Pain Assessment Tools by Age
Preschoolers
Simple self-report scales or assessment via observational scales
Pain Assessment Tools by Age School age (7-12 years)
Verbal numerical scales or visual analog scale
Pain Scale (5)
- Verbal Rating Scales
- Numerical Rating Scales
- Visual Analog Scale
- Graphic Rating Scales
- Faces Pain Scale
Pharmacologic Pain Management (9)
Non-opioid
- Acetaminophen
- Nonsteroidal anti-inflammatories (NSAIDs)
Opioids
- Morphine
- fentanyl
- methadone
- oxycodone
- Local anesthetics
Topical patch, cream or ointment
- Lidocaine
- Prilocaine or tetracaine
- Capsaicin
- Nerve blocks (lidocaine)
Adjuvant analgesics (5)
- Antidepressants
- Anticonvulsants
- Sedatives/anxiolytics
- Antihistamines
- Ketamine
Acetaminophen (Tylenol)
Absorption (3)
Metabolism (4)
Elimination(2)
Absorption:
- Oral: well absorbed
- Peak serum concentration: 60 minutes after oral dose
- Rectal: variable and prolonged; recommend q6h dosing
Metabolism:
- Extensively metabolized in the liver
- Primary mechanism: sulfate and gluconuronide conjugates
- **glutathione depletion leads to toxic levels of NAPQI
- Small amounts metabolized via CYP enzymes (NAPQI)
Elimination
Half-life:
- 3x in neonates compared to children
- Metabolites excreted via kidneys
Acetaminophen (Tylenol)
Mechanism of Action (3)
Mechanism of Action:
- Analgesic effects – inhibition of prostaglandin synthesis via COX enzymes increasing pain threshold
- Antipyretic effect – decreases production of endogenous pyrogens
- Minimal anti-inflammatory effects
Most commonly used analgesic in pediatrics for mild to moderate pain
Acetaminophen (Tylenol)
Available Dosage Forms (3)
Acetaminophen (Tylenol)
IV ($$$)
PO (liquid 160 mg/5 ml, tablets; max daily dose = 75 mg/kg/day)
PR (80 mg is the smallest dose; 20 mg/kg = max dose rectally)
What is the international name for acetaminophen?
Paracetamol
Acetaminophen (Tylenol) Side effects (1)
GI upset
Tylenol is often combined with opioids for…
More severe pain
o Indirect synergistic effects
NSAID (1)
Use
Used for treatment of mild to moderate pain, especially inflammatory-mediated conditions
NSAID (3)
Place in therapy
o Antipyretic
o Anti-inflammatory
o Analgesic activity