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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?
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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.