Workshop Manual - Faculty of pain medicine - Australian and New ...

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EXAMPLE 4: 12-year-old girl with burns to chest and abdomen. She needs dressing changes every 2-3 days. 1. RECOGNIZE • Patient may not appear to be in pain between dressing changes. • She may be very fearful of the dressing changes. • Staff on a burns ward will usually recognize that the patient has pain. 2. ASSESS • Pain may be moderate to severe, especially when old dressings removed. • Acute pain, non-cancer cause • Usually nociceptive mechanism but may have some neuropathic features if the burns have caused nerve damage. • Psychological factors (e.g. fear and anxiety) will be contributing to the pain. • Physical factors (e.g. infection of burns) may also be contributing. 3. TREAT • Non-drug treatments — Reassurance (“we can help the pain”, “your burns are healing well”) — Support from family, distraction — Patient may be able to remove own dressings — Surgery may be required PAIN MANAGEMENT EXAMPLES • Drug treatments — Fast release oral morphine 30 minutes before dressing change (0.3 mg/kg, e.g. 9 mg for a 30-kg girl) — Oral ketamine may be useful for very painful dressing changes (up to 5 mg/kg given 30 minutes before) — Entonox is sometimes helpful — Regular oral paracetamol and morphine if there is pain between dressing changes — Low dose amitriptyline (e.g. 5-10 mg at night) may be helpful if severe burn 36 ESSENTIAL PAIN MANAGEMENT
Summary Moderate to severe, acute burn (non-cancer) pain, usually nociceptive • Fear and anxiety about dressing changes • Reassurance and other non-drug treatments are important • Oral morphine is the best drug treatment • Regular paracetamol and oral morphine if there is pain between dressing changes PAIN MANAGEMENT EXAMPLES ESSENTIAL PAIN MANAGEMENT 37
Page 1: ESSENTIAL PAIN MANAGEMENT Workshop
Page 4 and 5: Essential Pain Management by Wayne
Page 6 and 7: INTRODUCTION Pain affects all of us
Page 8 and 9: WHY SHOULD WE TREAT PAIN CASE 1: Mr
Page 10 and 11: CLASSIFICATION OF PAIN Not all pain
Page 12 and 13: PHYSIOLOGY AND PATHOLOGY Understand
Page 14 and 15: The pain pathway 1. Periphery (Fig
Page 16 and 17: 2. Spinal cord (Fig 4) • The dors
Page 18 and 19: 4. Modulation (Fig 6) • The pain
Page 20 and 21: PAIN TREATMENT Because many factors
Page 22 and 23: Non-drug treatments Both physical a
Page 24 and 25: Where do analgesics work Local anae
Page 26 and 27: Drug effectiveness The effectivenes
Page 28 and 29: Possible barriers: • Patient fact
Page 30 and 31: 2. ASSESS To treat pain better, we
Page 32 and 33: 3. TREAT Treatment can be divided i
Page 34 and 35: PAIN MANAGEMENT EXAMPLES EXAMPLE 1:
Page 36 and 37: EXAMPLE 3: 24-year-old woman with a
Page 40 and 41: EXAMPLE 5: 51-year-old man with 2 y
Page 42 and 43: EXAMPLE 6: 55-year-old woman with m
Page 44 and 45: CASE DISCUSSIONS CASE 1: A 22-year-
Page 46 and 47: CASE 3: A 5-year-old girl has advan
Page 48 and 49: DISCUSSION TOPICS TOPIC 1: Treatmen
Page 50 and 51: APPENDICES Appendix 1: WHO Essentia
Page 52 and 53: Appendix 2: Medicine Formulary for
Page 54 and 55: Pethidine Generally very safe As fo
Page 56 and 57: Appendix 3: Paediatric Medicine Dos
Page 58 and 59: Appendix 5: Using Morphine for Canc

Workshop Manual - Faculty of pain medicine - Australian and New ...

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