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Acute Pain Management Clinical Nurse Specialist Acute Pain Management Inge Bateman Definition of Pain An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life. Pain is that experience we associate with actual or potential tissue damage. It is unquestionably a sensation in a part or parts of the body, but it is also always unpleasant and therefore also an emotional experience. IASP 1994 http://www.iasp-pain.org/terms-p.html Why Treat Pain? Humanitarian General Respiratory Cardiovascular Neuroendocrine system GI Psychological Chronicity Barriers to Effective Pain Management Lack of knowledge Inappropriate attitudes Pain management not a political issue! Poor pain assessment Do We Have a Problem? The medical profession sometimes find it difficult to believe the patient reporting pain. Copp 1990, Sofaer 1998 & Carter 1998. Effective Acute Pain Management In order to treat pain effectively it is necessary to assess it. Pain is most effectively assessed by means of self-reporting. Stannard,C 1998. Pain Assessment Always Assess Pain On Activity Pain Assessment Frequency Pain scoring tool Location of pain Description of pain Has the pain changed Side effects Review medication What analgesia has the patient used previously Patient’s knowledge Diagnosis Pain Score No pain = 0 Mild pain = 1 Moderate pain = 2 Severe pain = 3 Excruciating pain = 4 Pain Scores At rest On movement Deep Breathing Coughing Sedation Score Alert/awake = 0 Occasionally drowsy/slightly sedated = 1 Frequently drowsy/moderate sedated = 2 Difficult to rouse/severely sedated = 3 Concordance Information Drug Risk-benefits Listen How to Treat Acute Pain ‘Guideline For The Use Of Analgesic Drugs in Acute Pain Management’ Severe Pain Moderate Pain Mild Pain Paracetamol 1g 6 hourly Regularly (1) (Tablets/PR/Oral suspension) + Diclofenac 50mg 8 hourly Regularly (2) (PO/PR/ consider infusion) Paracetamol 1g 6 hourly Regularly (1) (Tablets/PR/Oral suspension) + Diclofenac 50mg 8 hourly Regularly (2) (PO/PR/ consider infusion) + Codeine 30-60mg 6 hourly Regularly PO Or Dihydrocodeine 30-60mg 6 hourly PO Regularly In addition to regularly analgesia: Morphine sulphate oral solution 10-35mg 2 hourly PRN for breakthrough pain Paracetamol 1g 6 hourly Regularly (1) (Tablets/PR/Oral suspension) + Diclofenac 50mg 8 hourly Regularly (2) (PO/PR/consider infusion) + Increments of IV bolus Morphine by doctor in order to establish rapid analgesia. Preferred route after established analgesia level is oral for patients who can take oral analgesia. Contact Acute Pain Service (APS) via bleep 328 The Joint Commission on Accreditation of Healthcare Organiszations and American Pain Society July 2000 Excuses for inadequate pain control appear to have run their course and will no longer be accepted because poor pain control is unethical, clinically unsound and economically wasteful.