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Chapter 39 - Pain Management for ChildrenWhat is Pain?•Pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (International Association for the Study of Pain, 1979)Definition of Pain•Pain is whatever the person experiencing pain says it is, existing whenever the person says it does•Pain Threshold varies•Pediatric pain experience involves the interaction of behavioral, developmental, physiologic, psychological,and situational factorsGate Control Theory•Gate control theory refers to a gating mechanism in the spinal cord that facilitates or inhibits pain transmission.•Stimulation of the larger afferent nerves can dull the pain.•Cognitive processes have an impact on pain transmission.•The gate control theory lends support for the use of both physiologic and psychological interventions in pain management. Types of Pain•Acute–Sudden onset and continuing for a limited period; experienced during and after procedures, postoperatively, from fractures, and from other bodily insults or injuries•Chronic–Unpredictable time limit, unlikely to resolve quickly, affecting child's ability to live a normal life; experienced in conditions such as juvenile rheumatoid arthritis, sickle cell disease, and cancer –Neuropathic pain– one of the most complex types of chronic pain to txPain•Acute-children experience this from IV starts, Injections, etc.•Chronic-juvenile arthritis, sickle cell disease and cancer •15% of children live with chronic painObstacles to Pain Management in Children•Myths–Neonates don’t feel pain –Fear of respiratory depression–Fear of addiction•Deficient knowledge•Inaccuracy of assessment•Lack of awareness of pain management interventions•Lack of communication with children/parents•Personal attitudes and beliefs•Fear of masking symptomsInfluences on Pain Assessment•Developmental level and emotional status •Culture and ethnicity•Previous experience with pain•Type and duration of pain•Personality type1
•Parental response to child's pain•Gender•Genetic variations Assessment According to Developmental Level•LOOK AT BOTH SUBJECTIVE & OBJECTIVE DATA•Crying can mean pain or hunger, or sleepiness, or anxiety•Vitals – provide info about neonatal acute pain –However physiologic signs are also affected by fever, illness, meds, •Little evidence to support changes in vitals to assess pain •Chronic pain child may NOT show behavioral ∆s that are noticeable to the nurse–Assess impact of pain on ADLs•Sleeping, eating, attending school, social & physical activities, interaction w/ friends & family•“say no to drugs” ages 5-6 may refuse/afraid to take meds ••Neonates and infants–May have a lower pain threshold –Facial expression – frown, grimace, wrinkled brow, expression of surprise, facial flinch–