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 management—one 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: