Managing Pain in Children (eBook)

A Clinical Guide for Nurses and Healthcare Professionals

Alison Twycross, Stephanie Dowden, Jennifer Stinson (Herausgeber)

eBook Download: PDF

2013 | 2. Auflage
John Wiley & Sons (Verlag)
9781118514634 (ISBN)

Infos

Providing an evidence-based, practical guide to care in all areas of children's pain management, Managing Pain in Children offers nurses and other healthcare professionals an introduction to the skills and expertise to manage children's pain effectively.

This fully-updated second edition first explores the relevant anatomy and physiology of children, the latest policy guidelines surrounding pain management and ethical issues involved in managing children's pain. Various pain assessment tools available for children and non-drug methods of pain relief are then explored and applied to practice in relation to acute pain, chronic pain, palliative care and the management of procedural pain.
The evidence base, assessment techniques, pain-relieving interventions, and guidance for best practice in both hospital and community settings are covered throughout, making this title an ideal resource for all nurses and healthcare professionals working with children.

Alison Twycross is Head of Department of Children's Nursing and Reader in Children's Nursing, London South Bank University, London, UK.

Stephanie Dowden is Clinical Nurse Consultant (CNC) for Paediatric Palliative Care at Princess Margaret Hospital for Children in Perth, Western Australia. Prior to this she was CNC in paediatric pain management at the Royal Children's Hospital in Melbourne Australia.

Jennifer Stinson is Post-Doctorial Research Fellow and Advanced Practice Nurse for the Chronic Pain Programme at The Hospital for Sick Children in Toronto, Ontario, Canada.

Inhalt

Cover 1
Title page 5
Copyright page 6
Contents 7
List of Contributors 8
Foreword 9
CHAPTER 1: Why Managing Pain in Children Matters 11
Introduction 11
What is Pain? 11
Consequences of Unrelieved Pain 12
Children’s Views about the Effectiveness of Pain Management 15
Misconceptions about Pain 16
Factors Affecting Healthcare Professionals’ Perceptions of Pain 17
Pain Management Standards 17
How Effective are Current Pain Management Practices? 18
Professional Accountability and Evidence-Based Practice 18
Managing Pain in Children is an Ethical Imperative 23
Summary 23
References 24
CHAPTER 2: Anatomy and Physiology of Pain 28
Introduction 28
The Nervous System 28
Misconceptions about the Physiology of Pain in Children 28
Pain Mechanisms 31
Transduction: The conversion of stimuli to electrical impulses 31
Transmission: Conveying impulses to the central nervous system 34
Perception 36
Modulation 37
Visceral Pain 40
Physiology of Chronic and Neuropathic Pain 40
Central sensitisation in chronic pain 41
Nervous System Development and Pain Sensation in Early Life 42
Summary 43
References 44
CHAPTER 3: Pain: A Biopsychosocial Phenomenon 46
Introduction 46
Biological Factors 46
Age 46
Cognitive development 48
Genetics 49
Temperament 49
Psychological Factors 51
Fear 51
Previous experiences of pain 51
Social Factors 52
Culture 52
Family learning 53
Gender 53
Summary 55
References 55
CHAPTER 4: Pharmacology of Analgesic Drugs 58
Introduction 58
Misconceptions 58
Addiction, Tolerance and Dependence 59
Addiction risk 60
Opioid weaning protocols 61
How Drugs Work 61
Pharmacodynamics 61
Pharmacokinetics 64
Routes of Drug Administration 65
Selection of Analgesic Drugs 65
WHO analgesic ladder 66
Non-Opioid Analgesic Drugs 68
Paracetamol (acetaminophen) 68
Nonsteroidal anti-inflammatory drugs 69
Opioid Analgesic Drugs 73
Tramadol 78
Opioid antagonists 79
Adjuvant Analgesic Drugs 80
Local anaesthetics 81
Ketamine 84
Other adjuvant analgesic drugs 85
Managing and Minimising the Non-Medical Use of Opioids 88
Summary 90
References 91
CHAPTER 5: Physical and Psychological Methods of Pain Relief in Children 96
Introduction 96
Physical Pain-Relieving Methods 96
Acupuncture 96
Heat and cold 98
Massage 99
Psychological Pain-Relieving Methods 100
Biofeedback 100
Cognitive behavioural therapy 101
Distraction 102
Hypnosis 105
Music therapy 107
Relaxation 108
Physical Methods of Pain Relief for Neonates 109
Breastfeeding 109
Facilitated tucking (or containment) 111
Kangaroo care (skin-to-skin contact) 112
Non-nutritive sucking 113
Sucrose 114
Swaddling 116
Summary 117
References 118
CHAPTER 6: Pain Assessment 122
Introduction 122
Healthcare Professionals’ Role in Pain Assessment 122
Pain Measurement and Pain Assessment 123
Assessing Pain in Children 123
Step 1: Taking a pain history 124
Step 2: Assessing the child’s pain using an developmentally appropriate pain assessment tool 127
Self-report tools 127
Behavioural tools 134
Physiological indicators 136
Pain Assessment Tools for Neonates 137
Pain Assessment in Ventilated Children 140
Pain Assessment in Cognitively Delayed Children 140
Choosing the Right Pain Assessment Tool 142
How Often Should Pain be Assessed? 144
Documentation 145
Summary 145
Key to Case Studies 145
References 147
CHAPTER 7: Managing Acute Pain in Children 150
Introduction 150
What is Acute Pain? 150
Causes of Acute Pain in Childhood 151
Injury 151
Childhood illnesses 151
Surgery/medical investigations 151
Medical conditions 152
Developmental disabilities 152
Pain Assessment 153
Physical and Psychological Interventions 153
Pharmacological Interventions 153
Non-opioids 153
Opioids 154
Local anaesthetics 154
Regional anaesthesia 154
Pain Management Guidelines 154
Aims of Pain Management 154
World Health Organization (WHO) analgesic ladder 156
Pain management in the community setting 156
Pain management in the hospital setting 157
Suggested Pain Management Regimes for Acute Pain 157
Non-opioid analgesia 157
Opioid analgesia 157
Patient-controlled analgesia 161
Other analgesic infusions 163
Optimising the Safety of Analgesic Drugs 164
Managing Adverse Effects of Opioids 166
Sedation/respiratory depression 166
Nausea and vomiting 167
Urinary retention 169
Pruritus (itch) 169
Constipation 169
Regional Anaesthesia 170
Central blocks 170
Peripheral blocks 170
Optimising the Safety of Regional Anaesthesia 171
Best practice management for regional analgesia 171
Problem solving 176
Complications of Regional Anaesthesia 176
Pain Problem-Solving 178
Transition to Oral Analgesics 180
Weaning PCA 181
Weaning regional anaesthesia infusions 181
Pain medications at home 181
Summary 181
Key to Case Studies 183
References 183
CHAPTER 8: Chronic Pain in Children 189
Introduction 189
What is Chronic Pain? 189
How Common is Chronic Pain in Children? 191
Aetiology or Causes of Chronic Pain 192
Common Chronic Pain Conditions in Children and Adolescents 193
Headache 193
Chronic abdominal pain 195
Musculoskeletal pain 197
Neuropathic pain 197
Common Types of Neuropathic Pain Conditions 198
Complex regional pain syndrome 199
Phantom limb pain 199
Pain Associated with Sickle Cell Disease 200
Factors Triggering and Maintaining Chronic Pain 201
Pain-Related Disability 203
The Impact of Chronic Pain on the Child and Family 203
The Cost of Chronic Pain 206
Management of Chronic Pain 206
Physical and psychological methods of pain relief 207
Physical pain-relieving interventions 207
Psychological therapies 208
Sleep hygiene 209
Complementary and alternative medicine 209
Pharmacological interventions 210
Invasive therapies 210
Multidisciplinary approach 210
Chronic pain clinics 210
Long-term outcomes 212
Summary 213
Key to Case Studies 214
References 214
CHAPTER 9: Palliative Care in Children 222
Introduction 222
What is Palliative Care? 222
What is Paediatric Palliative Care? 223
Death in Childhood 223
Causes of death in childhood 223
Where do children die? 224
How Many Children Need Palliative Care? 225
Conditions Requiring Paediatric Palliative Care 225
Where is Palliative Care for Children Delivered? 226
Challenges of home-based palliative care 227
When Should Palliative Care be Implemented? 227
Evidence Base for Palliative Care 228
Research priorities in paediatric palliative care 228
Quality in Palliative Care 228
Symptoms in Children Receiving Palliative Care 230
Pain and Symptom Management 230
Types of pain seen in PPC 230
Pain Assessment 232
Frequency of pain assessment 233
Choosing pain-relieving interventions 233
Managing Pain in Palliative Care 234
Management of intermittent/episodic pain 234
Management of persistent pain 234
Managing common opioid adverse drug effects 235
Managing breakthrough pain 235
Adjusting analgesia regimes 236
Pain crisis 237
Opioid rotation or switching 237
Intractable pain and palliative sedation 238
Other Pain-Relieving Interventions 238
Management of Non-Pain Symptoms 239
Assessing non-pain symptoms 239
When to treat non-pain symptoms 243
Physical and Psychological Methods to Relieve Pain and Other Distressing Symptoms 243
Misconceptions Relating to Paediatric Palliative Care 245
Ethical and Legal Issues in Paediatric Palliative Care 246
Futility in medical management 246
Euthanasia versus double effect 246
End-of-Life Care 247
Causes of pain and distressing symptoms at EOL 247
Diagnosing dying 247
Management of dying 248
After Death 249
Family bereavement care 249
Staff support 249
Summary 249
Key to Case Studies 250
References 251
CHAPTER 10: Management of Painful Procedures 256
Introduction 256
Procedure-Related Pain: Definition and Prevalence 256
Why is it Important to Manage Procedural Pain Effectively? 257
Factors that Influence a Child’s Response to Painful Procedures 258
Managing Procedural Pain: General Principles 259
Before the procedure 259
During the procedure 262
After the procedure 263
Using Nitrous Oxide to Manage Procedural Pain 264
Using Sedation to Manage Procedural Pain 267
Issues Relating to the Management of Specific Types of Procedural Pain 269
Needle-related pain 269
Topical local anaesthetics 269
Cryotherapy 270
Pain related to burn wound care 271
Pain related to cancer investigations 272
Pain related to immunisations 273
Procedural pain management in neonates 274
Summary 275
Key to Case Studies 276
References 277
CHAPTER 11: Where To From Here? 282
Introduction 282
Reasons for Suboptimal Practices 282
Knowledge deficits 283
Beliefs about pain in children 284
Decision-making strategies 285
Organisational culture 286
The Way Forward: Using a Knowledge Translation Model as a Framework for Improving Practice 287
Evidence 288
Context 293
Facilitating change 295
Researching Children’s Pain 296
Areas for Future Research 297
Summary 297
References 298
Index 302

Rezensionen

Reviews from 1st edition:

"A well-written resource that covers a range of
pertinent topics in pediatric pain...the evidence-based,
practical approach makes this guide a useful reference for both
novice and experienced health care professionals. This clinical
guide is a welcome addition to the pediatric pain literature and
would serve well as a textbook for a course in pediatric
pain." Pediatric Pain Letter

Produkt-Details

• Erscheint lt. Verlag: 7.10.2013
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Pädiatrie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Schmerztherapie
• Themenwelt: Medizin / Pharmazie ► Pflege ► Kinderkrankenpflege
• Schlagworte: Areas • children • children offers • Childrens • edition first • Ethical • evidencebased • Expertise • Explores • Guidelines • Healthcare • Introduction • Krankenpflege • Krankenpflege in der Pädiatrie u. Neonatologie • Krankenpflege in der Pädiatrie u. Neonatologie • Latest • Managing • Medical Science • Medizin • Nervous • nursing • Nursing Children & Young People • Pädiatrie • Pädiatrie • Pain • Pain Medicine • Pediatrics • Policy • Practical • relevant • Schmerzmedizin • Second • Skills • surrounding • System
• ISBN-13: 9781118514634 / 9781118514634