The nervous system of the newborn, including prematurity, is fully developed to receive, conduct, process and perceive painful stimuli to the same extent that an older child or adulto.Los basic mechanisms are similar, however, due to the neurophysiological and cognitive immaturity, there are some differences: for example, the pain impulse transmission occurs primarily in infants along unmyelinated C-fibers rather than A-delta fibers. There is less precision in the transmission of pain signal in the spinal cord and descending inhibitory neurotransmitter lacking. Consequently, infants may perceive pain more intensely than older children or adults, because their mechanisms are immature control downstream. In addition, the neonatal nervous system has higher concentrations (and diffuse) of substance P receptor sites, which limits their ability to modulate the pain experience. Therefore, although unable to speak and responses to pain are more nonspecific, we must start from the premise that any painful situation for the adult, also for the child. Moreover, when the latter can not be drawn against an adaptive response to painful stimuli and receives more anxiety as an adult. Pain is a complex psychological experience, which often cognitive and affective mechanisms are as important as tissue injury. The psychological factor is a determining factor in any assessment of pain.
Measuring pain in children is the subject of ongoing studies and comparisons. Apply many methods of evaluation. Some are subjective by scales which are dominated facial images reminiscent moods or colors or numerical scales (from a certain age.) Other times, they appreciate and quantify the external signs active behavior (crying, facial expression, movement, restlessness) or passive (decay, loss of appetite). Alterations of physiological parameters (respiration, heart rate, hormone levels) are more amenable to modification by other independent causes of pain.
been shown to measure pain is not an experience impossible. As a subjective variable, pain should be quantified by the patient, but as we shall see, in childhood this is impractical in many cases, so you need to develop reliable methods of valuation. Pain assessment must be consistent with the child's developmental stage, severity and chronicity of illness, medical or surgical procedure and the environment.
Assessment is the cornerstone of pain management. When it is evaluated with certainty, there is a "point of principle" well defined to determine the nature and degree of pain and evaluating the effectiveness of interventions to alleviate it.
To this end, two types of methods: self-and hetero.
self methods
Because pain is a subjective experience, self-assessment methods are the "gold standard" to measure. From 18 months of age, children incorporate into their vocabulary words to name the painful sensation. After three or four years, the development of the brain is sufficient to communicate the degree of pain (high or low). Therefore, these methods are generally used in children over three years.
Color Scale
consists of a rule, which goes from white to pink to bright red, almost black, up gradation of minimum to maximum pain pain. The patient indicates, according to the intensity of color, where your pain. Obviously, it is used in children over 5 years.
One of the methods used in chronic pain consultations are the color profiles. It gives the child a tracing, front and back and is asked to paint with colors your pain. Although there are exceptions, children often choose red, purple or black in the areas of maximum pain. The use of serial drawings to evaluate the development of pain.
faces Scale
is composed of a series of 5-6 faces expressing a different intensity of pain (from none to much). Asks the child to choose the face corresponding to their pain. Very young children tend to choose the ends, so it is recommended to use after three years. Scale
visual analogue (VAS)
consists of a template, whose numbers from 0 to 10 are representative of the intensity of pain. Can be used for children 6 and older. Has, as variation in the temperature scale (same, but vertical, color and shape of a thermometer).
hetero methods There
scales used to assess the body's response to pain. These scales are obviously reserved for those children who can not express their pain or in addition to the above. In this case, the assessor who, on a number of physiologically objective parameters, gives a numerical value.
behavior measures can be categorized into descriptions of behaviors per minute, conduct social or related to appetite and changes in the status and cognitive function. Facial action and cry acoustic characteristics are examples of very detailed descriptions of behaviors per minute. Although there appears to be a cry of pain absolutely identifiable characteristics that would identify a painful condition is a high-pitched cry, rough and intense.
facial expression has been the most widely studied of the behavioral assessment measures in pain. Is the indicator more reliable and consistent pain in all populations and as such should be considered the "gold standard" of behavioral responses to pain in children. Facial expressions of infants who experience acute pain include the following features: eyes tightly closed, brows, nostrils large and bulky, deep philtrum, square-shaped mouth and tongue tense and concave.
This, coupled with a series of physiological variables, make up the majority of the scales heteroevaluativas. One is the CRIES (Crying Requires O2, vital signs Increassed expression, Sleppless), I put below:
A very interesting article regarding the measurement of pain is " Validity and reliability of the Behavioural Observational Pain Scale for postoperative pain Measurement in Children 1-7 years of age " which appeared in the journal Pediatric Critical Care Medicine, in 2007, which examines the behavioral and physiological variables that can lead to an objective assessment of pain in children 1 to 7 years. You can download it here .
0 comments:
Post a Comment