Question

Discuss the differences in perception and alleviation of pain as experienced by pediatric, geriatric, gender and in special populations, such as addicted persons. How have recent laws changed to assure those in pain will receive proper analgesia in a hospital emergency room? How do we measure pain in children as opposed to adults? What are the benefits to using multiple measures as well as different behavioral assessment methods? How can health psychology help those experiencing chronic pain – and how do the prevailing theories of pain perception inform our approaches to treat chronic pain, and our continuing research?

Answer 1

According to IASP pain is defined as unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such changes.

Perception of pain : perception of pain in pediatric group is massive but their treatment is not justified. It is considered that they don't experience pain and don't remember pain which is untrue and which can adversely affect the growth and development, immunity, physiology of growth etc. Improper assessment of pain, inability to verbalize pain, changes in drug dosages are factors causing under treatment with pain management. Alleviation of pain involves pharmacology but to a large extend non pharmacology method as well. Breast feeding, skin to skin contact, distraction therapy are all best method for pain mangement.

Pain perception in geriatric is due to improper assessment, non reporting of geriatric group, altered absorption of pharamological agents due to ageing, misconception on tolerence and addiction to opoids drugs. Pain management in geriatric group is pharmacology agents eg. NSAID, non opiod analgesic, opoid analgesic and non pharmacology methods such as cognitive behavioral therapy, spiritual therapy, patient and care giver education etc.

Perception of pain in special group such as drug addicts are difficult to treat due to increased tolerance level, withdrawal, increased time spent to acquire the substance etc. Providers conception about patients condition, health care system issue in poviding special drugs and opoid concerns. Pain management in such group is done by pharmacology agents and non pharmacology methods such as diversion therapy eg. Gaming.

Recent laws in pain management are as follows:

1. Initial prescription for schedule 2 control dangerous substances or any opoids should only by given for 5 day supply for actute pain.

2.After 5 day supply, the practitioner can give not more than 30 day supply if necessary only after srcutinizing patients condition.

3. For issuance of medication for 3 months or longer, law enforcea patient to have a pain management agreement to ensure understanding of physician and patient about drug, it's uses, long term effects, chances of addiction, patients rights etc.

4. Mandatory CME for physician regarding pain management and it's drugs and it's side effects.

5. U.S drug enforcement administration is imposing steep cut in supply of schedule 2 dangerous drugs in 2018.

Pain measurement in children:

1. Infants - up to 4 weeks NPRS. It includes factors such as Crying, Requires oxygen above 95 percent, increasing vital signs, Expression and sleeplessness. It has scoring from 0-2

2. FLACC scales - 1 month to 4 years. It measures face, leg, activity, cancelability, cry and measuring scores from 0-2.

3. For older children many scales are used like self report visual analouge, Wong Baker facial expressions, pain rating scale .

Behavioral assessment methods.

There are various behavioral assessment methods to recognize pain in pediatric such as a) OSBD Observation Scale of Behavioral Distress b)PBRS Procedural Behavioral Rating Scale c)CAMPIS Child Adult Medical Procedure Interaction Scale d) FLACC