Figure 73.1 The stages of pain management
Figure 73.2 The three P’s of pain management
Figure 73.3 Interventions
Figure 73.4 The WHO two-step approach to pain management
Table 73.1 Consequences of unrelieved pain
Physical effects
- Rapid, shallow, splinted breathing, which can lead to hypoxaemia and alkalosis
- Inadequate expansion of lungs and poor cough, which can lead to secretion retention and atelectasis
- Increased heart rate, blood pressure and myocardial oxygen requirements, which can lead to cardiac morbidity and ischaemia
- Increased stress hormones which in turn increase the metabolic rate, impede healing and decrease immune function
- Slowing or stasis of gut and urinary systems, which leads to nausea, vomiting, ileus and urinary retention
- Muscle tension, spasm and fatigue, which leads to reluctance to move spontaneously and refusal to ambulate, further delaying recovery
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Psychological effects
- Anxiety, fear, distress, feelings of helplessness or hopelessness
- Avoidance of activity, avoidance of future medical procedures
- Sleep disturbances
- Loss of appetite
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Other effects
- Prolonged hospital stays
- Increased rates of readmission to hospital
- Increased outpatient visits
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Why managing pain in children is important
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