- Pain is an unpleasant sensation, an emotional response to that sensation and is associated with actual or potential tissue damage.
- Pain is always subjective and multifactorial involving both physical and psychological processes.
- The objective of effective relief of pain is to reduce the pain perceived by the patient to a tolerable level without causing serious side effects.
- A drop in ≥2 points on the pain scale in patients experiencing severe pain is clinically significant.
- Initial and subsequent pain scores must be recorded to determine analgesia effectiveness.
- Perform OPQRST assessment:
- Onset
- Provocation or palliation
- Quality of pain
- Region and radiation
- Severity
- Time
- Choice of pain relief is dependent on the aetiology of the pain and the pharmacology of the medication.
- PAINLOGTM is a visual analogue for assessing changes in pain level. Ask the patient to slide the pointer to match their pain level and record the score. Reassess as required.
- Bradypnoea & hypoventilation is a common side effect of analgesics.
- All patients receiving pain medication must be monitored with a pulse oximeter.
- Patients under extended care (e.g. 'ramped' patients) have usually received analgesia prior. Loading doses are not indicated in this setting.
- Evidence suggests that concurrent use of multiple pain-relieving strategies, including pharmacological and non-pharmacological interventions, provides superior pain relief when compared to any single approach to pain management alone.
- Communication:
- Empathy
- Acknowledge and validate the patients pain
- Alleviate their concerns and explain processes of pre-hospital care.
- Reassurance
- Establishes confidence in the care-giver and setting the expectation of analgesic effectiveness reduces patient suffering.
- Reassurance reduces psychophysiological reactions.
- Distraction
- Distract patients with conversation
- Particularly effective and necessary for paediatric patients.
- Provide alternative focus for patient to concentrate on.
- Useful in protracted extrications.
- Empathy
- Other:
- Patient Positioning
- Immobilisation & Splinting
- Cooling / Icing
Pharmacological Intervention:
- Paracetamol
- Cophenylcaine
- Ketamine (wafer only, using Volunteer setting)
- Methoxyflurane
Note: Medications form just one component of an effective analgesia regime and should, in conjunction with non-pharmacological approaches as well as each other, be used in a multimodal approach encompassing both opioid and non-opioid analgesics.
Note: Medications form just one component of an effective analgesia regime and should, in conjunction with non-pharmacological approaches as well as each other, be used in a multimodal approach encompassing both opioid and non-opioid analgesics.
- Record pain score before and after treatment to assess effectiveness.
- Regular vital signs recordings are necessary to confirm effectiveness as well as checking for possible adverse effects.
- Beware of the synergistic effects of combining pain relieving medications.
- Allow sufficient time for medication to take effect and follow the time intervals as described in the individual medication guidelines.
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