What is Pain

Pain is the disease’s most typical symptom. It is an unpleasant sensation that is located in a body district. It describes terms of a penetrating or tissue-destructive method (e.g., stabbing, burning, twisting, tearing, squeezing) or a physical or emotional reaction (e.g., scary, disgusting, sicking). Some pain of medium or higher severity is associated with anxiety and hence the urgency

Diagnosis

Self-report is the key to pain assessment. In or pre-verbal children, facial expression is the most valid indicator of pain; therefore, use a faces pain scale to assess severity. Pain should be evaluated by:

  • Duration
  • Severity, example: does the patient wake up because of the pain  Site
  • Character, e.g., stabbing, throbbing, crushing, cramp-like
  • Persistent or intermittent
  • Relieving or aggravating factors
  • Accompanying symptoms
  • Distribution of pain
  • In children, pain can assess by Childs’ crying voice, posture, movement, and color.

Treatment for Acute and Mild pain

Aspirin, Paracetamol, and Non -steroidal Anti-Inflammatory Agents (NSAIDs); these drugs are considered together because they are used for similar problems and may have the same mechanism of action.

 

Adult

A: Acetylsalicylic acid 600mg every 4 hours until the pain subsides

OR

A: Paracetamol 500- 100mg every 6-8 hours until the pain subsides.

Children 

A: Paracetamol 15 mg/kg/dose 4–6 hourly when required to a maximum of 4 doses per 24 hours;

Treatment for  the Severe Pain

Opioids are currently available as the most effective pain-relieving medications. They have the broadest range of effectiveness, providing the most reliable and efficient method for fast pain relief.

Adults : C: Tramadol tablets or injection 50-100mg every 6 hours or until the pain is controlled.

OR

              C: Morphine 10mg IV every 6 hours on a “when necessary” basis;  Children: 0.2mg/kg body weight IV every 6 hours.

For surgery and obstetric conditions

              C: Pethidine 100mg IM/ IV every 6 hours when necessary.

 

CAUTION‼ Opioids may cause respiratory depression; therefore, they use opioids carefully. In case of toxicity, reverse with the narcotic antagonist naloxone.

C: Naloxone 0.1-0.2mg IV intermittently. Max. Dose 10mg

Do not administer morphine in:

  • advanced liver disease
  • severe head injury
  • acute asthma
  • advanced chronic obstructive bronchitis, emphysema or other
  • respiratory disease with imminent respiratory failure
  • untreated hypothyroidism

Use morphine with extreme care if there is:

  • Recent or concurrent alcohol intake or other CNS depressants
  • Hypovolaemia or shock
  • In the elderly

Referral

Refer to Regional and Tertiary care for:

  • All children with moderate and acute severe pain
  • No response to oral pain control and unable to initiate opioids therapy
  • Uncertain diagnosis
  • Management of serious underlying conditions

Pain Associated with Trauma or Inflammation

See under Trauma and Injuries section

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