Misconception In Pain Management Essay

2716 words - 11 pages

There exist among a significant portion of the medical community views that infants and young children do not experience pain in the same way or to the same degree as adults. (Kline, Turnbull, Labruna, Haufler, DeVivio, & Ciminera, 2010).This view dates back many years (Howard, 2003) and is based on a number of misconceptions including a belief that the nervous systems of children are different and they do not experience pain to the same degree as an adult, (Mahay, 2009; “Control of Pain in Children (Paediatric Pain Management),” 2006) and that even if pain is experienced it will be transient and the patient will not remember it (Shepard, 2008; McClain, & Kain, 2005). This is contradicted ...view middle of the document...

, 2010). The cumulative result is often a failure to manage pain in infants and young children, to the detriment of the patients’ immediate treatment and recovery, and with possible long term negative health outcomes for the patient and the immediate family (Howard, 2003; Kline et al., 2010; Turner, H.N. 2005).

Assessing pain in infants and young children is difficult. Infants are not capable of verbalising their pain, (Mahay, 2009) and even older children often cannot communicate in a way that is comparable to the terms and descriptors used and understood by adults (American Medical Association, 2010). Several methods have been developed to assess pain in infants and young children, “with at least 20 different pain scales in existence for infants alone” (Howard, 2003, p.2465) in common use within medical facilities. These scales are dependant on the attending medical staff having both the skills and the time to perform the necessary evaluation (Ellis, McCleary, Blouin, Dube, & Rowley, 2007). Even where the practitioner is highly skilled, individual variations between paediatric patients may result in less than adequate assessments. Macintyre, Schug, Scott, Visser & Walker, 2010). It has been found that in older children self reporting is more accurate than observation scales (“Control of Pain in Children (Paediatric Pain Management),” 2006). This may demonstrate limitations with the scale that simply cannot be identified without some degree of patient input, which is unavailable from infants.
In addition to these pain assessment scales, one commonly used method of pain assessment relies on physiological measurements. This method negates to some degree the need for the patient to describe or detail their pain, and as such is considered a more accurate and reliable method of determining pain levels, however such measurements may not provide a satisfactory level of accuracy in determining the pain being experienced, due to the bodies natural tendency to correct physiological imbalances via homeostatic mechanisms. (Howard, 2003) The view of Gerik (2005) is that “Physiological measures (eg, heart rate and blood pressure) are helpful as adjuncts to self-report and behavioural observations. They are neither sensitive nor specific as indicators of pain.”(p. 297) and further note that “Clinicians frequently use vital signs as an adjunct to pain assessment, although little evidence exists to support the practice” (p. 297).

Maccagno (2009) identifies that where infants or young children cannot verbalise their own pain level parents and carers are often better placed to identify pain and distress in their own children due to the closer relationship and extended contact between them. This results in a greater understanding of the patients “normal” state and the ability to detect subtle changes, and to relate these changes to potential causes based on previous experience. Other studies support this assertion (Gerik, 2005).

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