6.1 Managing Procedure-Related Pain
Painless procedures (such as CT scanning, MRI positioning for radiotherapy, and
ultrasonic examination) that require patients to lie still, often on a cold,
hard surface, may be frightening and indirectly provoke pain and distress. For
patients older than 5 years, preparatory education about the sensations and
surroundings the patient will experience (Johnson, Rice, Fuller, et al., 1978)
and the use of hypnosis, distraction, imagery (Katz, Kellerman, and Ellenberg,
1987; Zeltzer, Altman, Cohen, et al., 1990), and relaxation (Pfaff, Smith, and
Gowan, 1989) may decrease distress and facilitate coping with the procedure.
Sedatives, including oral chloral hydrate, pentobarbital, and midazolam
(Sievers, Yee, Foley, et al., 1991), may be appropriate for painless procedures
that require patient cooperation in remaining still, particularly for children
under 6 years of age and for cognitively impaired patients. Because
pharmacologic sedation may result in the loss of protective reflexes, patients
must be closely monitored (American Academy of Pediatrics Committee on Drugs,
1992). Intrinsically painless procedures may exacerbate ongoing cancer-related
pain, and supplemental analgesia may be required (Table 20).
Plans for managing pain associated with painful procedures should address
Why is the procedure being performed? What is the expected intensity of pain?
What is the expected duration of pain? What is the expected intensity of
anxiety? What is the expected duration of anxiety? How often will the procedure
be repeated? How do parents think their child will react? What reaction do
adults predict for themselves? What is the meaning of the procedure for the
patient and the family?
PROCEDURE-RELATED PAIN IN ADULTS AND CHILDREN
Pharmacologic Strategies for Procedural Pain
Pharmacologic agents for management of procedural pain
Sedation for Procedural Pain
Pain in Neonates, Children, and Adolescents
MONITORING THE QUALITY OF PAIN MANAGEMENT