Pain Management and Procedural Sedation

Pain Types:

• Somatic – localized, constant, achy
  • Sites – skin, subcutaneous tissues, bone, muscle, blood vessels, connective tissue
• Visceral – poorly localized, diffuse, cramping
  • Sites – organs, linings of body cavities
• Neuropathic – poorly localized, shooting, burning, sharp, numbness, tingling
  • Sites – central and peripheral nervous system

Assessment:

• Subjective report
• OPQRST: used to discern reasons for symptoms and history in the event of an acute illness
  • Onset of the event
  • Provocation or palliation
  • Quality of the pain
  • Region and radiation
  • Severity
  • Time
• Vital Signs may be within normal limits with persistent pain
• Body Language – cultural considerations

Tools:

• N-PASS (neonates): Neonatal Pain, Agitation, and Sedation scale
• FLACC (children): Face, Legs, Activity, Cry, Consolability scale
• Numeric rating scale (some pediatrics, adults)
• Picture scale (multiple)
• PAINAD (advanced dementia): Pain Assessment in Advanced Dementia scale

Pharmacologic interventions:

• Local, systemic, non-opioid, opioid
• Using NSAIDs with opioids to decrease opioid dose and treat pain multimodally
• Adjuvant medications, such as antiemetics, antidepressants, anticonvulsants, laxatives, or corticosteroids, may also increase the effectiveness of opioid pain management
• Consider patient-administered nitrous oxide
• Infants (under 4 months) may be administered oral sucrose
• Pain patches, pain pumps

Nonpharmacologic interventions:

• Position of comfort
• Stabilization of affected area
• Superficial heat (infiltrated IV site)
• Superficial cold (fracture, sprain)
• Age-appropriate distraction techniques
• Relaxation techniques (deep breathing)
• Reduction of noxious stimuli
• Infants: sucking, swaddling, reduction of noxious stimuli, holding, cuddling