Pain Management

Lesley Foster

EB Nurse Clinical Nurse Specialist, (Paediatric) DebRA UK

Patients’ photographs have been removedfrom this presentation

Pain managementStart early

• 2 days old. Oromorph and paracetamol prior to dressing changes

Acute Pain from Bullae / Wounds

• Give prescribed analgesia• Prepare dressings• Lance blisters to prevent from

enlarging. Use Cryogesic spray (Ethyl Chloride) if pain / anticipatory fear

• Select atraumatic dressing • Use silicone medical adhesive remover

spray (Appeel) if adherence has occurred

Use a Pain Assessment Tool• Patient focused• Individual • Cultural / social• Assess and

formulate a baseline pain score

• Use a recognised tool

• Behavioural characteristics

• Physiologically induced changes

Non Pharmalogical Therapies

• Visualisation

• Guided imagery

Guided Imagery

A therapeutic technique that allows two peopleto communicate on a reality that one of them has chosen to construe through an altered state of consciousness and achieved in the process of imaging.

BH Whitaker

Pain Management

• Mild Pain – combine simple analgesia with a non steroidal e.g. paracetamol with ibuprofen

• Severe pain – Opioid analgesia and anxiolytic sedation e.g. midazolam

Fentanyl lozenges. Entonnox (occasional use)

• Chronic background pain – may require long acting morphine (MST)

• Fentanyl patches (Appeel for safe removal)• Neuropathic pain – may respond to low dose

amitriptylline or gabapentin

Peripheral opioid use• 10mg of morphine

sulphate in 15mg Intrasite gel with dressing changes

(0.2mg/kg of morphine)

Concentration may be increased for optimal effect

Peripheral opioids in inflammatory painArchives of Disease in Childhood 2004;89:679-681Watterson G, Howard R, Goldman A.

Dressings with ibuprofen?

• Biatain –Ibu• foam dressing with ibuprofen designed to

provide moist wound healing and reduce pain at the wound site.

• For moist wounds only. • Only just available.• Not licensed for those under 12 years!• ?absorption – stop oral anti inflammatory

drugs until further studies taken

The environment

• Child friendly

• Undisturbed

• Distraction available

• Close window, switch off fan

• Personal choice – be realistic.

Preparation

• Templates

• Dressings cut to size

• Anticipate – wound swab, adherence – Appeel spray –demonstrate before need

• Analgesia & / sedation given

• Check for stinging from products e.g. honey

Be realistic

• Don’t offer in hospital what is not available at home (e.g. entonnox)

• Don’t promise a product will not sting or adhere

• Consider schooling and time available