Pain Management: An Important Part of Care in the Field

Friday, March 8, 2013

David A. Miramontes, MD, FACEP, assistant chief of Fire and EMS and EMS Medical Director for the District of Columbia Fire and EMS, presented a lecture on current practices in pain management at the EMS Today Conference and Exposition in Washington, D.C., today.

Dr. Miramontes gave the attendees a brief summary of his department’s demographics and EMS response volume:

• The Washington. D.C.. service area is 61 square miles
• Nighttime population served = 582,000; but 1.2 million daily (M-F)
• D.C. Fire and EMS answers 162,000 calls for service annually, 130,000 are EMS runs  (80% of all runs)
• There are 98,000 transports  (72% BLS)
• Average transport time = 12 minutes
• Average drop time = 37 minutes

Miramontes told the audience that before you can treat pain properly, you have to understand what pain is. He presented a definition of pain from the International Association for the Study of Pain: “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage…”

He explained that pain really does have several purposes:

• It tells us something is wrong with our body that we can’t see otherwise. Example: Abdominal pain--gas, constipation, infection
• It helps us avoid dangerous things. Example: We touch a hot fire, we feel pain, we pull away with spinal reflex immediately.
• It helps us protect damaged body parts. Example: We shield injuries from physical contact and limit use of injured muscle/skin to promote healing.

Miramontes also explained the classifications of pain, an aspect that he feels all providers need to be keenly aware of when performing patient assessments:

• Acute – sudden in onset, subsides with treatment
• Chronic – persistent or recurrent, hard to treat
• Referred – pain “felt” somewhere other than its origin. Examples: heart attack felt in left arm, spleen rupture felt in left shoulder, gall bladder felt in right shoulder blade.

Miramontes noted that there are also a few other types of pain:

• Neuropathic – caused by damage or disease to the nervous system--tingling, burning, electrical “zapping”; "pins and needles”; bumping the “funny bone”
• Psychogenic – caused by mental, emotional, or behavioral factors. This type of pain is o less hurtful than pain from other sources; it's not “all in their head.”

He advised attendees that the Wong-Baker Pain Rating Scale is popular in all assessment circles for gauging patient pain levels (see image).
 
Other key areas Miramontes discussed included:
•    Pathophysiology of Acute and Chronic Pain
•    Non-Pharmacology Pain Management
•    Opiates in Pain Management
•    Intranasal Medication Therapy
•    Pharmacokinetics of Intranasal Route
•    Ketamine in Pain Management
•    Other pain medications

EMS Today conference sessions will continue through Saturday. The conference will return to D.C. next year, February 4-8, 2014. For details, go to www.EMSToday.com.