Pain relief and sedation

19
Pain relief and sedation

Chart shows prehospital adjustments in pain ladder of WHO with markings for non-opioids, weak opioids, strong opioids and non-opioids, opioid-sparing analgesia, et cetera.

Pain is often managed suboptimally in the pre-hospital environment. This is most commonly due to the pre-hospital care practitioner underestimating the patient’s condition, opting for inadequate pain relief, or for fear of overdosing on analgesia. It is now well documented that effective pain control improves patient outcomes and that pre-hospital care practitioners require a firm understanding of how to assess and manage pain.

Importance of pain relief

It is a natural instinct for medical professionals to want to alleviate a patient’s pain. However, there are further advantages to pain relief:

Psychological: further painful interventions and handling will not be received well by a patient already in pain. Timely pain management may also reduce cases of post-traumatic stress disorder and other chronic pain states.
Physiological: the sensation of pain triggers an ‘injury response’, wherein catecholamines and steroids are released and the immune system is activated to prepare the body to deal with stress. While beneficial in the short term, excessive stimulation by unrelieved pain can worsen patient outcome. Prolonged sympathoactivation can result in myocardial ischaemia and worsen head injury. Analgesia may also improve outcomes directly, for example in chest wall injuries, where pain relief may facilitate ventilation and adequate oxygenation.
Practical: a patient who is not distressed will help all involved to administer treatment calmly and effectively.