scholarly journals Neuroscience Nurses' Perceptions of the Barriers to Identifying and Treating Pain in Acutely Brain-Injured Adult Patients

2015 ◽  
Author(s):  
Kimberly Iannotti
Keyword(s):  
Pain Management ◽  
Adult Patient ◽  
Critically Ill ◽  
Pain Assessment ◽  
Life Support ◽  
Neurological Status ◽  
Assessment Tools ◽  
Neurological Patient ◽  
Altered Level ◽  
Brain Injured

<p>Pain management for the critically ill adult can be daunting. Numerous factors contribute to this challenging process including altered level of consciousness (LOC), inability to speak, life support measures, family input, level of sedation, paralyzing agents, restraints, cognitive impairment, and numerous other factors. The current practice related to pain management in the neurologically critically ill adult patient population is limited by inadequate pain scales, altered neurological status, and atypical pain-associated behaviors. Additionally, nurses are challenged by unclear practice guidelines. The critical care nurse is required to assess and manage pain, as well as implement specific interventions based on the patient’s exhibiting characteristics or behaviors. The purpose of this study was to explore the neuroscience nurses’ perception of the barriers to identifying and treating pain in the acutely brain-injured adult patient. Participants were registered nurses working on a Neurocritical Care Unit. The methodology included two short answer questions and 15 Likert format questions rating the frequency of specific barriers. Nurses reported declining neurological status and subjective assessment tools as the most frequently seen barriers to pain assessment and management. Development of pain assessment measures in the brain-injured acutely ill adult patient continues to be important. The need for nurse-driven research to explore alternate measures to identify pain in the neurological patient is indicated. Implications for advanced practice are discussed.</p>

scholarly journals The Impact of Pain Assessment on Critically Ill Patients’ Outcomes: A Systematic Review

2015 ◽  
Vol 2015 ◽  
pp. 1-18 ◽  
Author(s):  
Evanthia Georgiou ◽  
Maria Hadjibalassi ◽  
Ekaterini Lambrinou ◽  
Panayiota Andreou ◽  
Elizabeth D. E. Papathanassoglou
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Quality Assessment ◽  
Critically Ill ◽  
Pain Assessment ◽  
Critically Ill Patients ◽  
Methodological Quality ◽  
Assessment Tools ◽  
Current Evidence ◽  
The Impact

In critically ill patients, pain is a major problem. Efficient pain management depends on a systematic, comprehensive assessment of pain. We aimed to review and synthesize current evidence on the impact of a systematic approach to pain assessment on critically ill patients’ outcomes. A systematic review of published studies (CINAHL, PUBMED, SCOPUS, EMBASE, and COCHRANE databases) with predetermined eligibility criteria was undertaken. Methodological quality was assessed by the EPHPP quality assessment tool. A total of 10 eligible studies were identified. Due to big heterogeneity, quantitative synthesis was not feasible. Most studies indicated the frequency, duration of pain assessment, and types of pain assessment tools. Methodological quality assessment yielded “strong” ratings for 5/10 and “weak” ratings for 3/10 studies. Implementation of systematic approaches to pain assessment appears to associate with more frequent documented reports of pain and more efficient decisions for pain management. There was evidence of favorable effects on pain intensity, duration of mechanical ventilation, length of ICU stay, mortality, adverse events, and complications. This systematic review demonstrates a link between systematic pain assessment and outcome in critical illness. However, the current level of evidence is insufficient to draw firm conclusions. More high quality randomized clinical studies are needed.

2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats

2021 ◽  
Vol 24 (1) ◽  
pp. 4-30
Author(s):  
Paulo V Steagall ◽  
Sheilah Robertson ◽  
Bradley Simon ◽  
Leon N Warne ◽  
Yael Shilo-Benjamini ◽  
...  
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Multimodal Analgesia ◽  
Evidence Base ◽  
Pharmacological Therapy ◽  
Assessment Tools ◽  
Mental Wellbeing ◽  
Team Approach ◽  
Analgesic Drugs

Practical relevance: Increases in cat ownership worldwide mean more cats are requiring veterinary care. Illness, trauma and surgery can result in acute pain, and effective management of pain is required for optimal feline welfare (ie, physical health and mental wellbeing). Validated pain assessment tools are available and pain management plans for the individual patient should incorporate pharmacological and non-pharmacological therapy. Preventive and multimodal analgesia, including local anaesthesia, are important principles of pain management, and the choice of analgesic drugs should take into account the type, severity and duration of pain, presence of comorbidities and avoidance of adverse effects. Nursing care, environmental modifications and cat friendly handling are likewise pivotal to the pain management plan, as is a team approach, involving the cat carer. Clinical challenges: Pain has traditionally been under-recognised in cats. Pain assessment tools are not widely implemented, and signs of pain in this species may be subtle. The unique challenges of feline metabolism and comorbidities may lead to undertreatment of pain and the development of peripheral and central sensitisation. Lack of availability or experience with various analgesic drugs may compromise effective pain management. Evidence base: These Guidelines have been created by a panel of experts and the International Society of Feline Medicine (ISFM) based on the available literature and the authors’ experience. They are aimed at general practitioners to assist in the assessment, prevention and management of acute pain in feline patients, and to provide a practical guide to selection and dosing of effective analgesic agents.

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

2004 ◽  
Vol 13 (2) ◽  
pp. 126-136 ◽  
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 (&lt;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.

scholarly journals Validation of Two Pain Assessment Tools Using a Standardized Nociceptive Stimulation in Critically Ill Adults

2018 ◽  
Vol 56 (4) ◽  
pp. 594-601 ◽  
Author(s):  
Cristini Klein ◽  
Wolnei Caumo ◽  
Céline Gélinas ◽  
Valéria Patines ◽  
Tatiana Pilger ◽  
...  
Keyword(s):  
Critically Ill ◽  
Pain Assessment ◽  
Assessment Tools ◽  
Nociceptive Stimulation ◽  
Critically Ill Adults ◽  
Ill Adults

Acute Pain Management

2018 ◽  
Author(s):  
Nihar Patel
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Treatment Options ◽  
Postoperative Pain Management ◽  
Assessment Tools ◽  
Age Appropriate ◽  
Short And Long Term ◽  
Inflammatory Drugs ◽  
Postoperative Setting

Age-appropriate pain assessment and management is vital in the care of children with acute pain. Pain in children should be routinely and regularly assessed, documented, treated and reassessed with clear documentation. Poor pain management in the acute and postoperative setting can result in both short- and long-term consequences. The most effective analgesia plans are multimodal. This chapter focuses on the variety of treatment options for pain in the acute setting. Topics covered include age-appropriate pain assessment tools for children; the basics of age-appropriate pain management in children; as well as the role of opioids, nonsteroidal anti-inflammatory drugs, and patient-controlled analgesia in acute and postoperative pain management in children.

Considerations for neonatal and pediatric pain management

2019 ◽  
Vol 76 (19) ◽  
pp. 1511-1520 ◽  
Author(s):  
Pooja Shah ◽  
Anita Siu
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Pediatric Patients ◽  
Safety Data ◽  
Clinical Situation ◽  
Assessment Tools ◽  
Patient Specific ◽  
Pediatric Pain ◽  
Unique Challenge

Abstract Purpose Current literature and clinical practice guidelines on pediatric pain management are reviewed. Summary Acute pain is commonly present in neonatal and pediatric patients due to underlying disease states or procedures. Especially in institutions with limited pediatric pain services, it is imperative to describe the appropriate management of pain and pharmacotherapy options that are effective and safe in pediatric patients. Despite the knowledge of pain being an important aspect in the management of children, barriers exist, leading to suboptimal treatment. Addressing these barriers through education of healthcare practitioners, families, and patients will lead to optimizing the patient pain experience. Tools for pain assessment vary depending on the type of pain, the child’s age and understanding of pain, and the clinical situation. Pharmacotherapy options for pain management in neonates and pediatric patients include opioid and nonopioid agents. Efficacy and safety data on the use of medications for the treatment of pain in pediatric patients is described. The delivery of medication encompasses patient-specific factors and preferences. Strategies for opioid stewardship and management of iatrogenic withdrawal pose a unique challenge in pediatric patients. Conclusion The management of acute pain in neonates and pediatric patients should be a priority for all practitioners caring for these patients. Use of age-appropriate pain assessment tools and understanding of the mechanisms of action and roles in therapy of various nonopioid and opioid therapies can help optimize treatment of pain in neonatal and pediatric patients.

scholarly journals Pain management during the withholding and withdrawal of life support in critically ill patients at the end-of-life: a systematic review and meta-analysis

2020 ◽  
Vol 46 (9) ◽  
pp. 1671-1682
Author(s):  
Andres Laserna ◽  
Alejandro Durán-Crane ◽  
María A. López-Olivo ◽  
John A. Cuenca ◽  
Cosmo Fowler ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
End Of Life ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Life Support ◽  
Meta Analysis

Pain Management in the Critically Ill: What Do We Know and How Can We Improve?

1994 ◽  
Vol 5 (2) ◽  
pp. 159-168 ◽  
Author(s):  
Michele A. Alpen ◽  
Marita G. Titler
Keyword(s):  
Critical Care ◽  
Quality Improvement ◽  
Pain Management ◽  
Critically Ill ◽  
Pain Assessment ◽  
Pain Control ◽  
Critical Care Nurses ◽  
Critical Care Units ◽  
Knowledge And Attitudes ◽  
Nurses Knowledge

Pain management in the critically ill is a challenge and a problem of great concern for critical care nurses. The authors review research on pain in the areas of pain assessment, nurses’ knowledge and attitudes, pharmacologic interventions, and nonpharmacologic interventions for the management of pain. Although the research base is not completely developed in the critically ill population, implications for practice are provided, based upon the findings in populations akin to the critically ill. Strategies are outlined for achieving improved pain control in critical care units through education, adoption of standards on pain management, and quality improvement activities

Pain management

2019 ◽  
pp. 549-568
Author(s):  
John Curtin
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Rating Scales ◽  
Interdisciplinary Approach ◽  
Opioid Analgesics ◽  
Brief Pain Inventory ◽  
Assessment Tools ◽  
World Health ◽  
Numerical Rating ◽  
Strong Opioids

Pain is described as being whatever the experiencing person says it is, and their perception of pain is determined by their mood and morale and the meaning of the pain for them. Cancer pain is common, and prevalence is related to the stage of the illness: 59% in patients undergoing treatment, and 64% in those with advanced disease. Pain is multi-causal and multidimensional, and a holistic, interdisciplinary approach to assessment is necessary, encompassing physical, psychological, social, and spiritual aspects of pain (together are ‘total pain’). A narrative approach to pain assessment is helpful, keeping the focus on the patient and their experience. Pain assessment tools can also be used to identify where pain is and how much it hurts. These include: pain body map, visual analogue scales (VAS), verbal rating scales (VRS), numerical rating scales (NRS), and Brief Pain Inventory (BPI). Classifications of pain include acute and chronic pain, nociceptive pain caused by the stimulation of nerve endings, and neuropathic pain caused by nerve dysfunction or compression. Analgesic drugs may be given according to the World Health Organization's pain relief ladder: step 1, non-opioid analgesics such as paracetamol and non-steroidal anti-inflammatory drugs; step 2, mild opioids like codeine with or without non-opioid analgesics; and step 3, strong opioids like morphine with or without non-opioid analgesics. Non-pharmacological interventions for pain management include transcutaneous electrical nerve stimulation (TENS), massage, distraction, relaxation, breathing exercises, comfort measures, and presence of the nurse. Effective communication at all stages of management is essential.

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