Pediatrics : Complementary pain medicine

  • Complementary pain medicine
    • Classification of complementary and alternative medicine
      • Biologically based
      • Manipulative treatments
      • Energy based
      • Mind-body techniques
      • Alternative medical systems
  • Nursing Actions
    • Assess pain thoroughly and adequately
    • Administer medications in a timely manner
    • Evaluate and monitor the child’s response to treatments
    • Titrate analgesic medications to achieve optimal dosing
    • Make recommendations for alternate medications if needed
  • Consequences of untreated Pain in Infants
    • Acute Consequences
      • Periventricular-intraventricular hemorrhage
      • Increased chemical and hormone release
      • Breakdown of fat and carbohydrate stores
      • Prolonged hyperglycemia
      • Higher morbidity for neonatal intensive care unit patients
      • Memory of painful events
      • Hypersensitivity to pain
      • Prolonged response to pain
      • Inappropriate innervation of the spinal cord
      • Inappropriate response to nonnoxious stimuli
      • Lower pain threshold
    • Potential Long-Term Consequences
      • Higher somatic complaints of unknown origin
      • Greater physiologic and behavioral responses to pain
      • Increased prevalence of neurologic deficits
      • Psychosocial problems
      • Neurobehavioral disorders
      • Cognitive deficits
      • Learning disorders
      • Poor motor performance
      • Behavioral problems
      • Attention deficits
      • Poor adaptive behavior
      • Inability to cope with novel situations
      • Problems with impulsivity and social control
      • Learning deficits
      • Emotional temperament changes in infancy or childhood
      • Accentuated hormonal stress responses in adult life
    • Common Pain States in Children
      • Levels of Sedation
        • Minimal Sedation (Anxiolysis)
          • Patient responds to verbal commands.
          • Cognitive function may be impaired.
          • Respiratory and cardiovascular systems are unaffected.
        • Moderate Sedation (Previously Conscious Sedation)
          • Patient responds to verbal commands but may not respond to light tactile stimulation.
          • Cognitive function is impaired.
          • Respiratory function is adequate; cardiovascular system is unaffected.
        • Deep Sedation
          • Patient cannot be easily aroused except with repeated or painful stimuli.
          • Ability to maintain airway may be impaired.
          • Spontaneous ventilation may be impaired; cardiovascular function is maintained.
        • General Anesthesia
          • Loss of consciousness, patient cannot be aroused with painful stimuli.
          • Airway cannot be maintained adequately, and ventilation is impaired.
          • Cardiovascular function may be impaired.
      • Painful and invasive procedures
        • Procedural sedation and analgesia
      • Postoperative pain 
        • Associated with surgery
        • Combination of medications
      • Burn pain
        • Multiple components
        • Difficult and challenging to control
      • Recurrent headaches
        • Tension, dental braces, weakness of eye muscles, sinusitis, epilepsy, sleep apnea, injury
      • Recurrent abdominal pain
        • Common in children
      • Pain associated with sickle cell disease
        • ED visits for opioid treatment
      • Cancer pain in children
        • Most prevalent symptom is pain
      • Pain and sedation in end-of-life care
        • Comfort can be relief with a combination of opioids and adjuvant analgesics

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