pain management lesley foster eb nurse clinical nurse specialist, (paediatric) debra uk patients’...

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