Codeine Overused in Children: Alternatives Exist for Hard-to-Manage Pain

By Jacob Molyneux, senior editor

According to a story at MedlinePlus, a study in Pediatrics has found that codeine is still prescribed too often to children during ER visits, though it’s known that a small but significant subset of children metabolize the painkiller far more rapidly than do other children, leading to potentially dangerous results. As AJN‘s February CE article on treating the often severe and stubborn posttonsillectomy pain in children noted, there are other effective and safer options for children in pain, such as hydrocodone in combination with acetaminophen, as well as some non-opioid analgesics. Here’s a brief overview of the article:

Tonsillectomy, used to treat a variety of pediatric disorders, including obstructive sleep apnea, peritonsillar cellulitis or abscesses, and very frequent throat infection, is known to produce nausea, vomiting, and prolonged, moderate-to-severe pain. The authors review the causes of posttonsillectomy pain, current findings on the efficacy of various pharmacologic and nonpharmacologic interventions in pain management, recommendations for patient and family teaching regarding pain management, and best practices for improving medication adherence.

There’s often no perfect answer in pain management, but it helps to know the full range of available strategies, their safety, and how well they work. As with all CE articles, this one is free.

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2016-11-21T13:04:56-05:00April 23rd, 2014|Ethics, nursing perspective, pain management|1 Comment
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The Power of Imagination: Helping Kids with Sickle Cell Disease to Cope with Pain

By Sylvia Foley, AJN senior editor

Many people with sickle cell disease suffer from both acute and chronic pain, which can be severe. Although the exact mechanism isn’t known, the pain is believed to result when sickled erythrocytes occlude the vascular beds, causing tissue ischemia. Such pain, which often begins in early childhood, arises unpredictably. Although some pain crises may require ED visits, hos­pitalization, opioid treatment, or a combination of these, most are managed at home. Yet little is known about at-home pain management in people with sickle cell disease, especially children.

Table 2. Changes in Self-Efficacy, Imaging Ability, and Pain Perception in School-Age Children After Guided Imagery Training Table 2. Changes in Self-Efficacy, Imaging Ability, and Pain Perception in School-Age Children After Guided Imagery Training

Cognitive behavioral therapy (CBT) has shown promise in helping patients with other chronic illnesses to cope with pain. Cassandra Elaine Dobson and Mary Woods Byrne decided to test guided imagery, a form of CBT, among children enrolled at one sickle cell treatment clinic in New York City. They report on their findings in this month’s original research CE, “Using Guided Imagery to Manage Pain in Young Children with Sickle Cell Disease.” The abstract below offers a quick overview; if you click the image above, you’ll see an enlarged view of one table showing key results.

Objectives: The purposes of this study were to test the effects of guided imagery training on school-age children who had been diagnosed with […]

2017-07-27T14:47:16-04:00April 2nd, 2014|nursing research, pain management, patient engagement|0 Comments
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Posttonsillectomy Pain in Children: Safer, More Effective Treatment Strategies

By Shawn Kennedy, editor-in-chief

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One of the CE articles in the February issue is “Posttonsillectomy Pain in Children.” It might seem like a no-brainer—ice-collar, cold fluids, and acetaminophen with codeine, right? WRONG. As the article indicates, there’s a lot more to managing this stubborn, sometimes severe pain.

For one thing, there’s been a big reversal in choice of pain medication. Acetaminophen with codeine, long a mainstay in managing children’s pain, is no longer recommended—in fact, the FDA issued a black box warning last year saying that codeine should not be used because its metabolism rate in one subset of children can cause excessive sedation. Reports of three deaths and a case of nonfatal respiratory depression in children who received appropriate doses prompted the warning. […]

2016-11-21T13:05:19-05:00February 26th, 2014|nursing perspective, pain management|0 Comments
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When They Can’t Tell You About the Hurt: Assessing Pain in People with Intellectual or Developmental Disabilities

By Sylvia Foley, AJN senior editor

When S.M., a 47-year-old resident at a facility for people with intellectual or developmental disabilities, started hitting himself in the left eye, his caregivers weren’t sure why. S.M., whose developmental quotient is equivalent to that of a two- or three-year-old, couldn’t tell them. Some thought he was frustrated at not being allowed to drink as much coffee as he wanted; others thought a recent decrease in his medication—quetiapine (Seroquel)—might be a factor. But a chart review revealed that both his father and brother had a history of cluster headaches. Was S.M.’s behavior an indicator of headache pain? How could clinicians best assess him?

In this month’s CE feature, authors Kathy Baldridge and Frank Andrasik provide an overview of pain assessment in people with intellectual or developmental disabilities, summarize the relevant research, and discuss the applicability of the American Society for Pain Management Nursing practice guidelines for assessing pain in nonverbal patients. The guidelines describe various behavioral pain assessment tools, some of which might be useful with S.M. and others like him. Other assessment methods include

a search for pathologic conditions or other problems or procedures known to cause pain; the observation of behaviors that might indicate pain; and the use of proxy reports (also called surrogate reports) by people who know the person best, whether family caregivers or professionals.

S.M. was encouraged to draw himself and what the “hurt” felt like; two […]

2016-11-21T13:14:41-05:00December 14th, 2010|Ethics, nursing perspective, pain management|3 Comments
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Poor Assessment of Nursing Home Residents’ Pain — What Can Be Done?

A recent study sought to find out whether relatives and caregivers (proxies) understood residents’ pain well enough to assist in pain assessment and to discover what factors affected their judgments of pain. The findings showed, however, that their reports didn’t consistently match the pain ratings of nursing home residents themselves.

It’s particularly difficult to assess pain in cognitively impaired nursing home residents. This means that there’s a lot of suffering that goes untreated. This AJN article in the December issue discusses the findings of a new study on the topic and offers some recommendations we obtained from the study authors. Here’s another excerpt:

The authors suggest that pain management in nursing homes could be improved through caregiver education, including the implementation of pain assessment education in combination with treatment. They recommend basic training for nurses and nursing assistants on pain, pain behavior, and pharmacologic and nonpharmacologic pain treatment, such as “massage, applying warmth, mobility[, and] distractions with music or story telling.” They also suggest that “treatment effects could be determined more easily using a pain observation scale.”

So check out the article, and also let us know what else can we do to more accurately assess the pain of nursing home residents.

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2016-11-21T13:20:34-05:00December 16th, 2009|nursing research, pain management|0 Comments
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