Professional Documents
Culture Documents
Pain
Pain
Margo McCaffery
“An unpleasant sensory and emotional
experience associated with actual or
potential tissue damage or described in terms
of such. Pain is subjective.”
• Physiological Effects
changes in vital signs,
pupils
• Behavioral Cues
how the baby acts when
she is in pain
• Hormonal/Metabolic
Responses
what happens chemically
Physiological Responses
• variations in HR
• variations in BP
• increased ICP
• increased or decreased RR
• decreased sats or increase in oxygen requirement
• change in color (pale, poor perfusion or red,
increased perfusion)
• increased or decreased muscle tone
Behavioral Cues
• F-face (expression)
• L-legs (tone)
• A-activity
• C-cry
• C-consolability
score is tallied, similar to APGAR (0,1, or 2 for
each category)
greater than 4 is indicative of pain
behaviorally based
CRIES scale
• C-crying
• R-requires O2
• I-increased VS
• E-expression
• S-sleepless
Simple and easy to use-uses a scale of 1-10,
similar to APGAR scoring
score of 4 or greater requires intervention
objective and behavioral categories
NIPS (Neonatal Infant Pain Scale)
• ASPMN statement
• circumcisions are painful
• Unrelieved pain from circs can cause adverse
stress responses such as breath holding, apnea,
gagging, and vomiting
• neonates have the right to an anesthetic to
prevent the pain of the procedure
• suggest use of blocks or EMLA cream as well as
sucrose pacifier and developmental support to
assist these babies with coping
Management of Mild Pain
• developmental support
• parental involvement
• developmental support
• parental involvement
• developmental support
• parental involvement
• pharmacological management
• Morphine
Intermittent 0.05 mg-0.2mg/kg/dose may
give q1-8 hours
Continuous load with 100mcg/kg, then 10-
15 mcg/kg/hr
can have significant respiratory side
effects
observe for abdominal distension,
decreased bowel sounds, and urinary
retention
Management of Severe Pain
• Fentanyl
Intermittent 1-4mcg/kg/dose may give q2-4
hours
Continuous 1-5mcg/kg/hour
good choice for cardiac patients due to
decreased CV side effects
can cause chest wall rigidity in neonates
when given IVP
• Meperidine (demerol) - not recommended for
pediatrics 2° toxic CNS metabolites
Management of Severe Pain
• Methadone
respiratory effects outlast analgesia at such
dosing levels
drug of choice to support narcotic weaning
• Hydromorphone (dilaudid)
analgesic, narcotic; not for patients with
significant respiratory distress
the injectable form contains benzyl alcohol
which is not recommended for neonates
GOALS OF MANAGEMENT