兒童疼痛評估與處置之現況 A Review of Children's Pain Assessment and Management doi:10.6224/jn.51.6.20 護理雜誌, 51(6), 2004 The Journal of Nursing, 51(6), 2004 作者 /Author: 鄭夙芬 (Su-Fen Cheng) 頁數 /Page: 20-26 出版日期 /Publication Date: 2004/12 引用本篇文獻時, 請提供 DOI 資訊, 並透過 DOI 永久網址取得最正確的書目資訊 To cite this Article, please include the DOI name in your reference data. 請使用本篇文獻 DOI 永久網址進行連結 : To link to this Article: http://dx.doi.org/10.6224/jn.51.6.20 DOI 是數位物件識別碼 (Digital Object Identifier, DOI) 的簡稱, 是這篇文章在網路上的唯一識別碼, 用於永久連結及引用該篇文章 若想得知更多 DOI 使用資訊, 請參考 http://doi.airiti.com For more information, please see: http://doi.airiti.com
20 Children's Pain Assessment and Management International Association for the Study of Pain, 1986 McCaffery 1977 Acute Pain Management Guideline, 1992 Gillies, 1993; Hawley, 1984; Keuren & Eland, 1997 1969 Haslam 1970 pain experiences history self-report measured behavioral observation assessment physiological measurement Cheng, Hester, Foster, & Wang, 2003; Hester & Barcus, 1986; Keuren & Enland, 1997 Cheng et al., 2003; Hester & Barcus, 1986 151 07 7811151 309 51 6 93 12
21 Self-report measured 1994 Abu-Saad & Holzemer, 1981; Beyer & Aradine, 1986; Bieri, Reeve, Champion, Addicoat, & Ziegler, 1990; Eland & Anderson, 1977; Hester, 1979; Savedra, Tesler, Holzemer, & Ward, 1989; Wong & Baker, 1988 Savedra Tesler Holzemer Ward 1989 1994 Self-report pain scale Eland & Anderson 1977 4 Color tool Hester 1979 Poker chip tool Abu-Saad & Hozemer 1981 Visual Anaalogue Scale Beyer & Aradine 1986 Oucher Oucher Scale Wong & Baker 1988 Faces Scale Savedra, Tesler, Holzemer & Ward 1989 Adolescent Pediatric Pain Tool; APPT Bieri et al. 1990 Faces Pain Scale 1994 Pain Sensory Tool Hester 5 7 10 0 10 Oucher Oucher Wong & Baker Beyer & Aradine APPT 4 7 7 9 15 3 12 5 8 17 6 8 5 13 51 6 93 12
22 Children's Pain Assessment and Management Cheng 2002 background pain procedural pain pain acceptance pain expectation previous pain experience Piaget6 3 Cheng 2003 27% Behavioral observation assessment McGrath et al., 1985; Merkel, Voepel-Lewis, Shayevitz, & Malviya, 1997; Tarbell, Cohen, & Cohen, 1992 Hester Barcus 1986 Physiological measurement Pain observation scale McGrath et al. 1985 Children's Hospital Eastern Ontario Pain Scale; CHEOPS Tarbell, Cohen & Marsh 1992 Toddler- Preschool Postoperative Pain Scale Merkel et al. 1997 FLACC FLACC pain assessment tool 51 6 93 12
23 Gillies, 1993 McCafrey Wong 1993 R rights for pain treatment right drug right dosage right route of administration right time right treatment of side effects right approach right drug opioid drug non-opioid drug adjunct drug 2004 Ferrari, 1999; Keuren & Eland, 1997; Means, 1994 Meperidine Demerol Meperidine Meperidine Morphine Ferrari, 1999 EMLA EMLA EMLA right dosage titration non-steroidal antiinflammatory drags, NSAID adjunct drugs Anticonvulsants Ticyclic antidepressants Acetaminophen Aspirin Ibuprofen Ketorolac Diciofenac Codeine Fentanyl Morphine Oxycodone Methadone Meperidine Carbamazepine Phenytoin Clonazepam Imipramine 10 15mg/kg po q4h 10 15mg/kg po q4h 4 10mg/kg po q6 8h 0.15 0.5 mg/kg po q8 12h 0.5 1mg/kg po q4h 0.5 2 ug/kg IV q1 q2 0.08 0.1 mg/kg IV q2h 0.2 mg/kg po q3 4h 0.1 mg/kg IV or po q4h for 2 3 doses, then q6 12h. 0.1 mg.kg po 4 12h 0.8 1 mg/kg IV q2h 0.2 mg/kg qhs 2 3 prn 1 3mg/kg qhs 51 6 93 12
24 Children's Pain Assessment and Management ceiling effect 1997 Ferrari, 1999 right route of administration Ferrari, 1999 right time around-the- clock prn prn Pasek, 1997; Ferrari, 1999; Hester & Foster, 1993 right treatment of side effects Ferrari, 1999; Hester & Foster, 1993 right approach Ferrari, 1999; Keuren & Eland, 1997 Ferrari, 1999 1995a 1995b Hester & Barcus, 1986; Means, 1994; Walco, Halpern, & Conte, 2002 1997 7 4 774 792 1995a 109 13 16 51 6 93 12
25 1995b 115 29 31 2004 PCA 53 3 197 200 1994 2 3 239 252 Abu-Saad, H., & Holzemer, W. Z. (1981). Measuring children's self-assessment of pain. Issues in Comprehensive Pediatric Nursing, 5, 337 345. Acute Pain Management Guideline Panel. (1992). Acute pain anagement: Operative or medical procedures and trauma. Clinical practice guideline. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U. S. Department of Health and Human Services, AHCPR Pub No. 92-0032. Beyer, J. E, & Aradine, C. R. (1986). Content validity of an instrument to measure young children's perceptions of the intensity of their pain. Journal of Pediatric Nursing, 1, 386 395. Bieri, D., Reeve, R. A., Champion, G. D., Addicoat, L., & Ziegler, J. B. (1990). The Faces Pain Scale for the self-assessment of the severity of pain experienced by children: Development, initial validation, and preliminary investigation for ratio scale properties. Pain. 41(2), 139 150. Cheng, S., Hester, N. O., Foster, R. L., & Wang, J. (2003). Assessment of the Convergent Validity of pain intensity in the Pain Sensory Tool. The Journal of Nursing Research, 11(2), 93 100. Cheng, S. (2002). A Multi-Method Study of Taiwanese Children's Pain Experiences. Unpublished doctoral dissertation, University of Colorado Health Sciences Center, Denver, Colorado. Eland, J. M., & Anderson, J. E. (1977). The experience of pain in children. In A. Jacox (Ed.), Pain: A source book for nurses and other health professionals (pp. 453 473). Boston, MA: Lettle Brown. Ferrari, L. R. (1999). Anesthesia and pain management for the pediatrician. Baltimore & Londeon: Johns Hopkins University press. Gillies, M. L. (1993). Post-operative pain in children: A review of the literature. Journal of Clinical Nursing, 2(5), 5 10. Haslam, D. R. (1969). Individual differences in pain threshold and level of arousal. British Journal of Psychology, 58, 139 142. Hawley, D. D. (1984). Postoperative pain in children: Misconceptions, descriptions and interventions. Pediatric Nursing, 10 (1), 20 23. Hester, N. O. (1979). The preoperational child's reaction to immunization. Nursing Research, 28(4), 250 254. Hester, N. O., & Barcus, C. S. (1986). Assessment and management of pain in children. Pediatrics: Nursing Update, 1(14), 2 8. Hester, N. O., & Foster, R. L. (1993). Integrating pediatric postoperative pain management into clinical practice. Journal of Pharmaceutical Care in Pain & Symptom Control, 1(4), 5 34. International Association for the Study of Pain (1986). Pain terms: A current list with definitions and notes on usage. Pain, 3, s216 s221. Keuren, K. V., & Eland, J. A. (1997). Perioerative pain management in children. Nursing Clinics of North America, 32(1), 31 44. McCaffery, M. (1977). Pain relief for the child. Pediatric Nursing, 3(1), 11 16. McCaffrey, M., & Wong, D. L. (1993). Nursing interventions for pain control in children. In N. L. Schechter, C. B. Berde, & M. Yaster (Eds.), Pain in Infants, Children and Adolescents. Baltimore: Williams and Wilkins. McGrath, P. J., Johnson, G., Goodman, J. T., Schillinger, J., Dunn, J., & Chapman, J. A. (1985). CHEOPS: A behavioral scale for rating postoperative pain in children. Advances in Pain Research and Study, 9, 395 402. Means, L. K. (1994). Pain relief for children: New concepts, new methods. Contemporary Pediatrics, 11, 70 93. Merkel, S. I., Voepel-Lewis, T., Shayevitz, J. R., & Malviya, S. (1997). The FLACC: A behavioral scale for scoring postoperative pain in young children. Pediatric Nursing, 23(3), 293 297. Pasek T. (1997). Controlling pain: Assessing pediatric pain. Nursing, 27(8), 18. Savedra, M., Tesler, M., Holzemer, W., & Ward, J. (1989). Adolescent pediatric pain tool (APPT) preliminary user's manual. San Francisco: University of California. Tarbell, S. E., Cohen, I. T., & Marsh, J. L. (1992). The toddlerpreschooler postoperative pain scale: An observational scale for measuring postoperative pain in children aged 1-5. Pain, 50, 273 280. Walco, G. A., Halpern, S. L., & Conte, P. M. (2002). Pain in Infants and Children. In C. D. Tollison, J. R. Satterthwaithe, J. W. Tollison (Eds.), Practical Pain Management (pp. 748 759). Philadelphia: Lippincott Williams & Wilkins. Wong, D. L., & Baker, C. M. (1988). Pain in children: Comparison of assessment scales. Pediatric Nursing, 14(1), 9 17. 51 6 93 12
26 Children's Pain Assessment and Management A Review of Children's Pain Assessment and Management Su-Fen Cheng ABSTRACT: Pain is a subjective experience, thus, whenever the children stated they are in pain, the pain is existed. In the case of children under 3 years old, however, or those who have difficulty expressing themselves or controlling their behavior, nurses are required to make a judgment about whether they are just moody or are truly experiencing pain; an accurate assessment must be made before pain relief is administered. To relieve pain is one of the obligations of nurses. The purposes of this paper are not only to describe current trends in children s pain assessment and management in the clinical setting, but also to discuss issues related to pain assessment tools. Pain assessment should include a history of pain experience, self-reported measures, behavioral observation measures and physiological measures. Pain management includes pharmacological and non-pharmacological methods. A multimethod approach for managing children s pain is needed. Key Words: Assessment of children's pain, pain management. RN, PhD, Associate Professor, Department of Nursing, Fooyin University. Address correspondence to: Su-Fen Cheng, No. 151, Chin-Hsueh Rd., Ta-Liao Hsiang, Kaohsiung County 831, Taiwan, ROC. Tel: 886(7)781-1151 ext. 309; E-mail: sv132@mail.fy.edu.tw 500 35-50 10 10 5 ACLS ICU training 20-35 36 04-22586688 1603 0921-004376 E-mail:ls@lshosp.com.tw FAX:04-22581356 04-22586688 1630 E-mail:ls2018@lshosp.com.tw FAX:04-22582960 www.lshosp.com.tw 51 6 93 12