Navigation Links
'Pain in the ICU' report suggests comprehensive approach

(Northbrook, IL, April 7, 2009) Managing pain in the ICU is an ongoing and significant challenge for the critical care team. However, new reports suggest that taking a comprehensive approach to pain management may be the key to managing pain in the ICU and even decreasing the incidence of preventable pain.

Published in the April issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), the two reports titled, Evaluation of Pain in ICU Patients and Pain Management Principles in the Critically Ill, are the first in a series of five papers developed by critical care experts from the Critical Care Institute of the ACCP, American Association of Critical-Care Nurses, and the American Society of Health-System Pharmacists. As a whole, the article series reviews the complex nature of pain experienced by a critical care patient and details the benefits of taking a comprehensive approach to pain managementone that combines pharmacotherapy with behavioral, social, and communication strategies, interdisciplinary teams, and family involvement.

The Complex Nature of Pain in the ICU

Patients in the ICU have unique characteristics that provide significant challenges for the critical care team. Critically ill patients may suffer disproportionately compared with other patients, experiencing significant pain from their life-threatening illness or injury, and additional pain associated with simple procedures, such as endotracheal suctioning or the removal of a chest tube. Furthermore, critically ill patients are often unable to effectively communicate pain to their caregivers, making it difficult to assess and manage pain sufficiently.

"The complex nature of caring for the critically ill, particularly in the area of pain management, requires a more holistic approach to patient care," said Curtis N. Sessler, MD, FCCP, author of an accompanying editorial and Medical Director of Critical Care, Virginia Commonwealth University Medical Center, Richmond, VA. "An interdisciplinary critical care team who uses standard and alternative methods of pain assessment, evaluation, and management is essential for optimal patient care."

Assessing Pain In Critically Ill Patients

Standard tools for pain assessment and evaluation, which typically rely on a patient's own verbal report, may be ineffective for critically ill patients who are unable to communicate. In these situations, the critical care team can use alternative methods for pain assessment, including the following:

  • Patient Risk ProfileThis tool identifies the patient's risk of pain prior to a procedure and allows the team to administer preemptive pain management, whereby decreasing the incidence of pain.
  • Nonverbal CommunicationPatients who cannot speak or have difficulty speaking may be able to point or blink when referring to a pain scale.
  • Analgesic TrialTo verify the presence of pain, the ICU team can administer a low dose of first-line analgesic followed by observation of the patient's pain-related behaviors.
  • Surrogate ReportingIf patients are unable to communicate, the ICU team can use "surrogate reports" from family members who may be able assess a loved one's pain based on history.

"Critical care professionals have come to value family members of patients as an integral part of the care process," said Kathleen Puntillo, RN, CNS, DNSc, FAAN, lead author of the Evaluation article and Co-Director of the Critical Care/Trauma Program, Department of Physiological Nursing, University of California, San Francisco, CA. "Although family members' surrogate pain reports may be helpful, their effectiveness still requires more research."

Managing Pain in Critically Ill Patients

Organ failure, sepsis, and other medical complications can make it difficult to manage pain in the critically ill. The use of opioids or related medications is the standard method of acute pain control, and the choice of which opioid to use is carefully selected based on the uniqueness of each patient's pain management issues, as well as potential side effects and drug interactions.

"Much of the research on pain medications has been conducted in non-ICU settings. The ICU clinician must extrapolate and apply this research to the care of critically ill patients who frequently have tenuous and rapidly changing clinical conditions that complicate pharmacotherapy decisions," said Brian L. Erstad, PharmD, FCCM, lead author of the Pain Management report and Professor, University of Arizona College of Pharmacy, Tucson, AZ.

"Although pain in the ICU is inevitable, there are a number of unique interventions that critical care professionals can use to anticipate, manage, and even prevent pain from occurring," said James A.L. Mathers, Jr., MD, FCCP, President of the American College of Chest Physicians. "Physicians, nurses, pharmacists, and other members of the extended critical care team should continue to make effective pain assessment and management a priority in the ICU."


Contact: Jennifer Stawarz
American College of Chest Physicians

Related medicine news :

1. Whiplash may produce delayed jaw pain
2. Hypnosis Eases Pain of Breast Cancer Surgery
3. Whiplash May Result in Delayed Jaw Pain
4. Figure Skater Peggy Fleming, HealthSaver Says: Take Pains For Back Strains, 2nd Most Common Doctor Complaint
5. Knee Pain May Signal Lung Cancer
6. Consumer Reports Analysis: Drugs for Nerve Pain, Fibromyalgia Effective, But Not Always Best
7. PainCare Receives $14.4 Million in Cash From Completed Sale of South Florida Ambulatory Surgery Centers
8. New study examines brain-gut relationship in those suffering with stomach pain or discomfort
9. Pain patients at risk for sleep apnea
10. Painless Hemorrhoid Treatment Adds Management Punch
11. Ninety Percent of Polled Pain Care Professionals Express Fear of Regulation
Post Your Comments:
(Date:10/13/2015)... ... , ... Sir Grout of Greater Boston donated an expansive, seven room ... House Charities® (RMHC®). This donation was made in an effort to give back to ... inception. , “We believe strongly in the Ronald McDonald House Charities, and they are ...
(Date:10/13/2015)... (PRWEB) , ... October 13, 2015 , ... ... its newest technology platform, ENGAGE, at HIMSS’s Patient Engagement Summit . HealthAware ... , ENGAGE delivers innovative health programs and interventions via mobile devices that provide ...
(Date:10/13/2015)... ... October 13, 2015 , ... Element ... products, introduced a new company, RightSensor™ LLC, an Internet of Things (IoT) hardware ... RightSensor™ provides a fully-managed approach for customers requiring sensor hardware for critical data ...
(Date:10/13/2015)... ... , ... NavaFit Inc. today announced the launch of its NavaFit app for ... local fitness & sporting events, and stay motivated. Users can download the ... us to get more serious about fitness and wellness, individuals are constantly looking for ...
(Date:10/13/2015)... , ... October 13, 2015 ... ... Omega-3, a first-of-its kind product that targets the unique health needs of ... of the American Pregnancy Association ( ), utilizes Nordic Naturals’ exclusive, ...
Breaking Medicine News(10 mins):
(Date:10/13/2015)... , Oct. 13, 2015  A minimally-invasive treatment just ... the United States.  After more than 10 years of ... 9 approved the use of High Intensity Focused Ultrasound ... cells while protecting surrounding tissue and minimizing chances for ... George Suarez , a pioneering Miami ...
(Date:10/13/2015)... N.J. , Oct. 13, 2015  ContraVir ... the "Company"), a biopharmaceutical company focused on the ... announced the closing of its previously announced underwritten ... stock and warrants to purchase up to 3,000,000 ... fixed combined price to the public of $3.00. ...
(Date:10/13/2015)... , Oct. 13, 2015  Measurement in accountable ... and balancing financial incentives, but gaps in measurement ... care and health systems. A new, peer-reviewed ... Managed Care explores measurement gaps for ... sets. --> --> ...
Breaking Medicine Technology: