The Evolution of Pain Management in the Critically Ill Trauma Patient

Pain is a traumatic experience and discomfort for all patients, especially critically ill patients; if not treated properly, it can have harmful effects. Critical illnesses are usually painful, both because of the underlying source of the disease and the necessary procedures performed to monitor and care for these patients. Pain induces anxiety, sleep deprivation, disorientation, agitation, delirium, and often become chronic depression. Psychological factors (sleep deprivation, anxiety, and delirium) can also increase the perception of pain. Pain assessment is required for proper pain management. Opioids are commonly used in pain management, but acetaminophen, dexmedetomidine, and gabapentin have more advantages. The recent trend is multimodal analgesia, which uses a combination of analgesic drugs with different mechanisms of action. Another trend is the increasing use of pain relievers, which can control pain and relieve anxiety.

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Measuring quality indicators to improve pain management in critically ill patients

Journal of Critical Care ◽

10.1016/j.jcrc.2018.10.027 ◽

2019 ◽

Vol 49 ◽

pp. 136-142 ◽

Cited By ~ 5

Author(s):

Marie-José Roos-Blom ◽

Wouter T. Gude ◽

Jan Jaap Spijkstra ◽

Evert de Jonge ◽

Dave Dongelmans ◽

...

Keyword(s):

Pain Management ◽

Critically Ill ◽

Quality Indicators ◽

Critically Ill Patients

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Sedation, Paralysis, and Pain Management of the Critically Ill Obese Patient

Critical Care Management of the Obese Patient ◽

10.1002/9781119962083.ch6 ◽

2012 ◽

pp. 45-57

Author(s):

Christopher G. Hughes ◽

Lisa Weavind ◽

Pratik P. Pandharipande

Keyword(s):

Pain Management ◽

Obese Patient ◽

Critically Ill

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Pain Assessment and Management in Critically Ill Intubated Patients: a Retrospective Study

American Journal of Critical Care ◽

10.4037/ajcc2004.13.2.126 ◽

2004 ◽

Vol 13 (2) ◽

pp. 126-136 ◽

Cited By ~ 112

Author(s):

Céline Gélinas ◽

Martine Fortier ◽

Chantal Viens ◽

Lise Fillion ◽

Kathleen Puntillo

Keyword(s):

Pain Management ◽

Critically Ill ◽

Pain Assessment ◽

Assessment Tool ◽

Quebec City ◽

Pharmacological Interventions ◽

Relieve Pain ◽

Self Reports ◽

Data Collection Instrument ◽

Pain Documentation

• Background Little research has been done on pain assessment in critical care, especially in patients who cannot communicate verbally.• Objectives To describe (1) pain indicators used by nurses and physicians for pain assessment, (2) pain management (pharmacological and nonpharmacological interventions) undertaken by nurses to relieve pain, and (3) pain indicators used for pain reassessment by nurses to verify the effectiveness of pain management in patients who are intubated.• Methods Medical files from 2 specialized healthcare centers in Quebec City, Quebec, were reviewed. A data collection instrument based on Melzack’s theory was developed from existing tools. Pain-related indicators were clustered into nonobservable/subjective (patients’ self-reports of pain) and observable/objective (physiological and behavioral) categories.• Results A total of 183 pain episodes in 52 patients who received mechanical ventilation were analyzed. Observable indicators were recorded 97% of the time. Patients’ self-reports of pain were recorded only 29% of the time, a practice contradictory to recommendations for pain assessment. Pharmacological interventions were used more often (89% of the time) than nonpharmacological interventions (<25%) for managing pain. Almost 40% of the time, pain was not reassessed after an intervention. For reassessments, observable indicators were recorded 66% of the time; patients self-reports were recorded only 8% of the time.• Conclusions Pain documentation in medical files is incomplete or inadequate. The lack of a pain assessment tool may contribute to this situation. Research is still needed in the development of tools to enhance pain assessment in critically ill intubated patients.

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