Background & Aims
Vulnerable patients with intellectual disability in pain present a management challenge to pain physicians given the multidimensional and subjective experience.
This is especially complex if they had missed formal special needs education in their childhood years.
Methods
Case report and content review
Results
We present a 54-year-old Down’s Syndrome patient who sustained displaced left 7th to 10th rib fractures after falling from a bus, complicated by a small left hemothorax and small pericardial effusion who was trauma activated at the emergency department for acute pain management. He presented to the emergency department after poor sleep for three days with tender left chest upon examination. History and behaviour were corroborated with his helper and carers. Parenteral medications were started while he was fasted for scans and possible surgery before conversion to oral medications. Specific considerations of regional blocks for acute multiple rib fractures were challenging. Modality for consistent assessment of pain by multiple healthcare professionals was adopted and shared.
Conclusions
Pain in patients with intellectual disability remains challenging especially with barriers of verbal and individualised non-verbal communication, where caregivers should be oriented to the disorder to be actively involved in the acute and chronic pain management of the patient.
References
1. Salah NE, Rania SA, Mohamed SN. Pain Management in the Most Vulnerable Intellectual Disability: A Review. Pain Ther. 2023 Aug; 12(4): 939–961.
2.https://www.aaidd.org/intellectual-disability/definition
3. Pain in Individuals with an Intellectual Disability: Scope of the Problem and Assessment Challenges: IASP fact sheet https://www.iasp-pain.org/resources/fact-sheets/pain-in-individuals-with-an-intellectual-disability-scope-of-the-problem-and-assessment-challenges/
Presenting Author
Sara Ang
Poster Authors
Topics
- Pain in Special Populations: Intellectual, Developmental, and Functional Disability