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Blog Stomach Pain AIEM

Our latest podcast is out and can be streamed here!

Pain. The most common presenting complaint in emergency departments.1 Considered the 5th vital sign, it’s the bread and butter of all clinical assessments. Whether in the ED, ICU, or the prehospital environment, pain management falls under all practitioners’ scope of practice and should be treated accordingly.

Long Story Short (LSS) at the bottom

Definition:

Pain is a complex interaction of sensory, emotional and behavioural factors. Pain is an unpleasant sensory and emotional experience, associated with actual or potential tissue damage or described in terms of such damage.2

Pathophysiology

So how do we perceive pain? How do our brains interpret pain, and how does it affect our bodies?

An easy way to think about how pain works is to think of it like an electrical system. The Nociceptors (pain receptors) respond to changes in pressure, temperature, and chemicals. The picture below gives a good description of the pathway that pain takes, from translation, transmission, and modulation to perception.

Acute vs chronic

Time is an important factor when it comes to pain. We often see patients in the acute phase of their pain. Acute pain is usually short and limited in duration, with an identifiable cause (trauma, surgery, or inflammation).2

Chronic pain occurs when acute pain is inadequately treated.

Emotional vs sensational pain

Often, we forget about the emotional pain that a patient may be experiencing. We can measure a patient’s pain using scales, but we often forget about the emotional aspect of pain and the often traumatic experiences that go along with it. Pain management also includes effective splinting, patient comfort, keeping the patient warm and talking to the patient. Do not underestimate the power of compassion.

How to accurately measure pain

Pain is a subjective sign that will differ from patient to patient. Previous painful experiences and expectations will often cause different pain scores between patients. There are several ways to assess pain, using visual and analog scales. Most often, a verbal numerical pain scale is used. The patient is asked to rate their pain on a scale of 1 – 10, with 1 being little/no pain and 10 being the most severe/excruciating pain. The Wong-Baker faces can be used as they are a visual tool that is easily understood. It is validated to be used on children as young as 5 years old. Regardless of the tool you use, pain should be measured to determine the effectiveness of your treatment.

Choices of drugs

We have a plethora of medication that we can use to treat pain. It is important to know when to use which medication and what dose to use.

  • Entonox
  • Penthrox
  • NSAIDS
  • Paracetamol
  • Morphine
  • Ketamine
  • Fentanyl

Multimodal Pain Management 

Opioid free ED?

The term “opioid free” seems like an unachievable target within the current EM spaces. Morphine, Fentanyl, Pethidine are all medications that we are used to using and are comfortable with. There are, however, problems associated with the use of opioids. There can be severe side effects (particularly in the elderly population), addiction/misuse, poor titration practices and there is no consensus on the optimum dose.3

More information and some really awesome podcasts on the topic can be found here.

LSS:

  • Patients experience pain differently
  • Assess the pain using a validated scale
  • Know your medication and dose ranges
  • Opioids might not be the best choices – consider other medication!

References:

  1. Abdolrazaghnejd A, Banaie M, Tavakoli N, Safdari M, Rajabpour-Sanati A. Pain Management in the Emergency Department: a Review Article on Options and Methods. Adv J Emerg Med. 2018;2(4): e45
  2. South African Society of Anaesthesiologists. South African Acute Pain Guidelines (2017) Available from: https://www.sajaa.co.za/index.php/sajaa/article/view/1960
  3. O’Connor, A. B., Zwemer, F. L., Hays, D. P., & Feng, C. (2010). Intravenous opioid dosing and outcomes in emergency patients: a prospective cohort analysis. The American journal of emergency medicine28(9), 1041–1050.e6. https://doi.org/10.1016/j.ajem.2009.06.009
Blog Stomach Pain AIEM

Our latest podcast is out and can be streamed here!

Pain. The most common presenting complaint in emergency departments.1 Considered the 5th vital sign, it’s the bread and butter of all clinical assessments. Whether in the ED, ICU, or the prehospital environment, pain management falls under all practitioners’ scope of practice and should be treated accordingly.

Long Story Short (LSS) at the bottom

Definition:

Pain is a complex interaction of sensory, emotional and behavioural factors. Pain is an unpleasant sensory and emotional experience, associated with actual or potential tissue damage or described in terms of such damage.2

Pathophysiology

So how do we perceive pain? How do our brains interpret pain, and how does it affect our bodies?

An easy way to think about how pain works is to think of it like an electrical system. The Nociceptors (pain receptors) respond to changes in pressure, temperature, and chemicals. The picture below gives a good description of the pathway that pain takes, from translation, transmission, and modulation to perception.

Acute vs chronic

Time is an important factor when it comes to pain. We often see patients in the acute phase of their pain. Acute pain is usually short and limited in duration, with an identifiable cause (trauma, surgery, or inflammation).2

Chronic pain occurs when acute pain is inadequately treated.

Emotional vs sensational pain

Often, we forget about the emotional pain that a patient may be experiencing. We can measure a patient’s pain using scales, but we often forget about the emotional aspect of pain and the often traumatic experiences that go along with it. Pain management also includes effective splinting, patient comfort, keeping the patient warm and talking to the patient. Do not underestimate the power of compassion.

How to accurately measure pain

Pain is a subjective sign that will differ from patient to patient. Previous painful experiences and expectations will often cause different pain scores between patients. There are several ways to assess pain, using visual and analog scales. Most often, a verbal numerical pain scale is used. The patient is asked to rate their pain on a scale of 1 – 10, with 1 being little/no pain and 10 being the most severe/excruciating pain. The Wong-Baker faces can be used as they are a visual tool that is easily understood. It is validated to be used on children as young as 5 years old. Regardless of the tool you use, pain should be measured to determine the effectiveness of your treatment.

Choices of drugs

We have a plethora of medication that we can use to treat pain. It is important to know when to use which medication and what dose to use.

  • Entonox
  • Penthrox
  • NSAIDS
  • Paracetamol
  • Morphine
  • Ketamine
  • Fentanyl

Multimodal Pain Management 

Opioid free ED?

The term “opioid free” seems like an unachievable target within the current EM spaces. Morphine, Fentanyl, Pethidine are all medications that we are used to using and are comfortable with. There are, however, problems associated with the use of opioids. There can be severe side effects (particularly in the elderly population), addiction/misuse, poor titration practices and there is no consensus on the optimum dose.3

More information and some really awesome podcasts on the topic can be found here.

LSS:

  • Patients experience pain differently
  • Assess the pain using a validated scale
  • Know your medication and dose ranges
  • Opioids might not be the best choices – consider other medication!

References:

  1. Abdolrazaghnejd A, Banaie M, Tavakoli N, Safdari M, Rajabpour-Sanati A. Pain Management in the Emergency Department: a Review Article on Options and Methods. Adv J Emerg Med. 2018;2(4): e45
  2. South African Society of Anaesthesiologists. South African Acute Pain Guidelines (2017) Available from: https://www.sajaa.co.za/index.php/sajaa/article/view/1960
  3. O’Connor, A. B., Zwemer, F. L., Hays, D. P., & Feng, C. (2010). Intravenous opioid dosing and outcomes in emergency patients: a prospective cohort analysis. The American journal of emergency medicine28(9), 1041–1050.e6. https://doi.org/10.1016/j.ajem.2009.06.009

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