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Module 6: Pain Management C E N L E End-of-Life Nursing Education Consortium Pediatric Palliative Care C E N L E Pediatric Palliative Care

Module 6: Pain Management C C E E N N L L E E End-of-Life Nursing Education Consortium Pediatric Palliative Care C C E E N N L L E E

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Page 1: Module 6: Pain Management C C E E N N L L E E End-of-Life Nursing Education Consortium Pediatric Palliative Care C C E E N N L L E E

Module 6:Pain Management

CCEENNLLEEEnd-of-Life Nursing Education Consortium

Pediatric Palliative Care

CCEENNLLEE Pediatric Palliative Care

Page 2: Module 6: Pain Management C C E E N N L L E E End-of-Life Nursing Education Consortium Pediatric Palliative Care C C E E N N L L E E

CCEENNLLEE Pediatric Palliative Care

Pain Defined

Pain is a subjective response

Pain in childhood can be acute or chronic

Children's pain is influenced by many factors

Page 3: Module 6: Pain Management C C E E N N L L E E End-of-Life Nursing Education Consortium Pediatric Palliative Care C C E E N N L L E E

CCEENNLLEE Pediatric Palliative Care

Scope of the Problem

Children’s pain experience

Effect of pain on quality of life

Page 4: Module 6: Pain Management C C E E N N L L E E End-of-Life Nursing Education Consortium Pediatric Palliative Care C C E E N N L L E E

CCEENNLLEE Pediatric Palliative Care

Populations at risk Chronic conditions Trauma/injury Neurological impairment Neonates/infants Non-English speaking Cultural, gender stereotyping

Page 5: Module 6: Pain Management C C E E N N L L E E End-of-Life Nursing Education Consortium Pediatric Palliative Care C C E E N N L L E E

CCEENNLLEE Pediatric Palliative Care

Barriers to Pain Relief

Healthcare professionals

Healthcare system

Related to parents/children

Page 6: Module 6: Pain Management C C E E N N L L E E End-of-Life Nursing Education Consortium Pediatric Palliative Care C C E E N N L L E E

CCEENNLLEE Pediatric Palliative Care

Myths Related to Pain and Pain Management in Children

Respiratory depression Addiction Child that is sleeping/or playing

does not have pain Presence of pain indicates

worsening of disease and approaching death

Page 7: Module 6: Pain Management C C E E N N L L E E End-of-Life Nursing Education Consortium Pediatric Palliative Care C C E E N N L L E E

CCEENNLLEE Pediatric Palliative Care

Facts About Childhood Pain

Opioid addictions are rare Repeated exposure to painful

procedures leads to increased anxiety and perception of pain

Studies have shown that children as young as 3 years old can use pain scales

Carter et al., 2004; Goldman et al., 2006; Hockenberry & Wilson, 2006; Schecter, 2003

Page 8: Module 6: Pain Management C C E E N N L L E E End-of-Life Nursing Education Consortium Pediatric Palliative Care C C E E N N L L E E

CCEENNLLEE Pediatric Palliative Care

Myths Related to Neonatal/Infant Pain

Incapable of feeling pain Immature nervous system Incomplete myelinization No memory Objective assessment

impossible Neonates cannot

communicate pain Analgesics unsafe

Page 9: Module 6: Pain Management C C E E N N L L E E End-of-Life Nursing Education Consortium Pediatric Palliative Care C C E E N N L L E E

CCEENNLLEE Pediatric Palliative Care

Facts About Neonatal/Infant Pain

Pain perception occurs early in life

Neonates exhibit physiologic and behavioral cues

Page 10: Module 6: Pain Management C C E E N N L L E E End-of-Life Nursing Education Consortium Pediatric Palliative Care C C E E N N L L E E

CCEENNLLEE Pediatric Palliative Care

Modifying Contextual Factors of Pain Expression in Infants

Behavioral state Postnatal age Severity of medical illness Technician effects/procedural modifiers Environmental stress Sensitization after repeated stimulation Total number of invasive procedures Time since last painful procedure

Page 11: Module 6: Pain Management C C E E N N L L E E End-of-Life Nursing Education Consortium Pediatric Palliative Care C C E E N N L L E E

CCEENNLLEE Pediatric Palliative Care

Impact of Pain

Research asked ‘What is it like to have a child with pain?’ Unendurable Sense of helplessness Sense of total commitment Unprepared/unknowledgeable Horrible/frightening No pain in heaven

Ferrell et al., 1994a & 1994b

Page 12: Module 6: Pain Management C C E E N N L L E E End-of-Life Nursing Education Consortium Pediatric Palliative Care C C E E N N L L E E

CCEENNLLEE Pediatric Palliative Care

Developmental Aspects of Pain

Infants

Toddlers

Page 13: Module 6: Pain Management C C E E N N L L E E End-of-Life Nursing Education Consortium Pediatric Palliative Care C C E E N N L L E E

CCEENNLLEE Pediatric Palliative Care

Developmental Aspects of Pain

Pre-school School age

Page 14: Module 6: Pain Management C C E E N N L L E E End-of-Life Nursing Education Consortium Pediatric Palliative Care C C E E N N L L E E

CCEENNLLEE Pediatric Palliative Care

Developmental Aspects of Pain

Adolescents

Page 15: Module 6: Pain Management C C E E N N L L E E End-of-Life Nursing Education Consortium Pediatric Palliative Care C C E E N N L L E E

CCEENNLLEE Pediatric Palliative Care

Special Populations

Injury/trauma ER PICU

Page 16: Module 6: Pain Management C C E E N N L L E E End-of-Life Nursing Education Consortium Pediatric Palliative Care C C E E N N L L E E

CCEENNLLEE Pediatric Palliative Care

Special Populations

Cancer pain

Chronic non-malignant pain

Page 17: Module 6: Pain Management C C E E N N L L E E End-of-Life Nursing Education Consortium Pediatric Palliative Care C C E E N N L L E E

CCEENNLLEE Pediatric Palliative Care

Special Populations

Sickle cell Numerous complications of SCD

result in pain Vaso-occlusive crisis, priapism,

dactylitis, splenic sequestration, spinal cord compression and avascular necrosis of joints

Page 18: Module 6: Pain Management C C E E N N L L E E End-of-Life Nursing Education Consortium Pediatric Palliative Care C C E E N N L L E E

CCEENNLLEE Pediatric Palliative Care

Special Populations

Pancreatitis Musculoskeletal/rheumatic

Juvenile Primary Fibromyalgia Juvenile Idiopathic Arthritis Complex Regional Pain Syndrome

Page 19: Module 6: Pain Management C C E E N N L L E E End-of-Life Nursing Education Consortium Pediatric Palliative Care C C E E N N L L E E

CCEENNLLEE Pediatric Palliative Care

Special Populations

Neurocognitive impairment Pain experience Pain indicators Effect of uncontrolled pain Assessment

Knowing child Recognizing patterns Intersubjective process with HCP