Pain Assessment and Monitoring in the Pre-hospital Setting

Pain assessment in conscious and interactive patients is typically performed using questionnaires, visual analog scales (VAS), or numerical rating scales:

Pain assessment is more complex in patients with altered consciousness or those unable to express pain verbally. In these cases, pain may be suspected through clinical indicators (facial expressions, groans, tearing…) as well as signs of sympathetic hyperactivity (tachycardia, hypertension…).

The degree of pain is frequently underestimated, making it advisable to err on the side of caution when treating it. Regular pain assessments should be conducted and documented to apply appropriate treatment, evaluate therapeutic response, and monitor for potential adverse effects.

PAIN MANAGEMENT IN POLITRAUMA PATIENTS

Polytrauma patients experience pain as a result of both sustained injuries and diagnostic or therapeutic procedures performed.

The primary goal of analgesia in polytrauma patients is to provide optimal comfort while minimizing negative physiological responses to pain.

Uncontrolled nociceptive stimuli have deleterious effects on patient outcomes:

• Increased skeletal muscle tone, resulting in heightened pain.
• Increased arteriolar smooth muscle tone leading to ischemia.
• Sympathetic hyperactivity:
  • Hypertension
  • Increased oxygen consumption
  • Increased cardiac output
  • Increased protein catabolism
• Pain-induced immobility with elevated risk of:
  • Thromboembolic disease
  • Ventilatory insufficiency and associated complications (atelectasis, pneumonitis, infections…)
• Emotional impact triggering anxiety, insomnia, stress, and even psychosis.