TYK395

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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