Myths of Pain Management

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Podcast Show Notes:

Welcome again to DitchMedics.com. In this podcast we discuss common myths of pain management in EMS. This is a great topic because, as we will discuss, pain management is a large part of what we do in EMS…or what we should do anyway. But I believe this is area we often struggle at in EMS. We prioritize so much of our care before pain management. When, in reality, pain management should be on the forefront of our minds.

Managing a patient’s pain is obviously a humane consideration. We should certainly care about our patient’s level of discomfort. But it’s more than that. Managing a patient’s pain level also promotes better outcomes. Better outcomes across a wide spectrum of patients. Just think about that…you can improve patient outcomes, morbidity and mortality, just by reducing pain. Just by assessing and treating pain. We can and must do that better.

I think it, like most other weaknesses in EMS, comes down to a failure of training. I never really understood the negative impact that pain has on a patient until I began my exposure to the critical care world. It was this training that really delved into the pathophysiology of pain. The impact that pain has, not only on a patient’s emotional, but physical wellness. Understanding this concept, that managing pain is central to our patient’s overall health, is the underlying premise of this discussion.

 

Myths:

  • We currently treat pain effectively
  • Pain causes an identical response in every patient
  • Pain management interventions are universal for all patients
  • Avoid analgesia in critical patients due to side effects
  • Avoid pain management due to masking effects
I discuss each of these myths in the show. Modern pain management strategy understands the importance of minimizing the emotional and physical toll of pain on our patients. These myths have no place in your current practice.

Assessment:

Managing a patient’s pain starts with assessment.

  • Understanding the role of the subjective and objective aspects of an assessment is important.
  • Subjectively were looking at a patient’s perception of their pain.
  • Objectively were looking at the clinical indications of pain. The physical telltale signs of discomfort. Plus the physiological changes often exhibited in the vital signs.

Treatment:

Our treatment options include  non-pharmacological and pharmacological interventions.

  • Non-pharmacological interventions are those such as patient positioning, reduction  and lengthening of fractured bones, and utilizing the  principle of RICE. These interventions  often will manage the patient’s pain,  minimizing the amount of pharmacological intervention required.
  • The quantity of  available pharmacological interventions are numerous. This comes down to your scope of practice and protocols. Different classes of drugs have different effects on the body and thus different available uses for pain management. In the podcast I discuss the use of fentanyl and ketamine, two of my personal favorite drugs for pain mangement. Notably missing from this discussion is morphine. I have little use for morphine anymore, as there are many superior options available.
    • Fentanyl – a high potency, synthetic opioid. A greatly superior side effect profile. Much safer to administer in patients with hemodynamic compromise.
    • Ketamine – a dissociative anesthetic. Ketamine  has traditionally been used for its sedative properties. However, recent research and use has shown it to be an effective analgesic agent.

 

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Thanks for all of your support. Talk to you again soon. – Derrick