Which of the following patients is NOT in “pain”, as defined by the IASP (and
discussed above):
a) A 13 year-old female with crampy abdominal discomfort
b) A 12 day-old male crying with an incarcerated inguinal hernia
c) A 5 year-old female who cries when approached for IM vaccination
d) A 23 year-old man complaining of lumbar back pain and asking for a “work
note” despite normal physical exam and radiographic findings
e) A 24 month-old male crying and refusing an IV placement
f) All of the above are in pain
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Answer
Answer f. Pain is defined by the IASP as “an unpleasant sensory and emotional
experience associated with actual or potential tissue damage, or described in
terms of such damage.” Importantly, patients do not have to be able to verbalize
the experience in order to be in pain. Equally important is the concept that pain
is always subjective. In other words, whatever the patient says the level of pain
is, it is. Fear of IV or IM needles (and potential tissue damage) qualifies as pain
by this definition. While the patient described in (D) may warrant investigation
as to possible ulterior motives (such as opioid-seeking or malingering), in the
meantime his pain symptoms should be assumed to be as he describes them and
treated appropriately.
Notes
- This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.
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