Acute Pain Management in Intensive Care Patients: Facts and Figures

Abstract

Pain is an unpleasant experience for all patients including intensive care patients; if it is not treated properly, it has deleterious effects on patients' acute and chronic well-beings. In ICU patients, it causes sympathetic stimulation leading to adverse hemodynamic effects and after discharge, these patients are at the higher risk for developing chronic pain and post-traumatic stress disorders. Apart from racial and regional factors, sleep deprivation, anxiety, and delirium increase the pain perceptions. Pain assessment is a prerequisite for adequate pain management. The ICU patients are sedated and ventilated, and assessment scales differ depending on whether the patient is able to communicate. There are different pain assessment scales for both groups of patients. The preferred mode of delivery of analgesic medication is intravenous route as intramuscular and subcutaneous route are not reliable for drug delivery in these patients. Patient and nurse controlled analgesia gives better sense of pain control. In the treatment of pain, opioids are the commonly used medications, but paracetamol, dexmedetomidine, and gabapentin are increasingly used. Newer trends are multimodal analgesia, where the combinations of analgesic medications with different mechanism of action are used. Another trend is increasing use of analgosedation; they not only control the pain but also relieve anxiety.

Frequent problems and their management among mechanically ventilated critically ill elderly patients

“…Pain is a common sensory perception among critically ill elderly patients, this culminates into sleep disturbance, anxiety, and posttraumatic stress disorders (Shaikh et al , 2018). Nurses’ knowledge, attitude and practices of pain management are essential components of promoting patient comfort (Kiwanuka and Masaba, 2018) notwithstanding the nursing team’s common underestimation of the severity of pain among critically ill elderly patients.…”

Pain in critically ill patients: A concept analysis

“…Sleep deprivation is an important contributing factor for increased pain response in ICU patients. In burns patients, it is a well-realized fact that if these patients do not have proper night sleep, the intensity of pain during the day time is higher [23] . Furthermore, many of these patients have a history of chronic pain, which complicates their course and treatment [15] .…”

“…In ICU patients, it causes sympathetic stimulation leading to adverse hemodynamic effects and after discharge; these patients are at the higher risk for developing chronic pain and post-traumatic stress disorders. The adverse psychological and physiologic effects of inadequate pain control in critically ill patients are long lasting and significant [23] . The stress response from painful stimuli activates the autonomic nervous system, causing the release of catecholamines and stress hormones (e.g., glucagon, cortisol), which can result in vasoconstriction and interfere with tissue perfusion and oxygen delivery.…”

“…Pain also suppresses natural killer cell activity and results in a decrease in the number of cytotoxic T cells, leading to a reduced neutrophil phagocytic activity. Acute pain in ICU patients is a greatest risk factor for developing debilitating chronic, persistent, and neuropathic pain [23] . Acute pain can be the major risk factor for developing delirium and persistent pain is often neuropathic.…”

“…Another behavioural scale called the Critical-Care Pain Observation Tool may also be used. In SUPPORT study, it is concluded that surrogates can identify the patient's pain 73% of the time and accurately estimate its severity of pain 53% of the times [23] .…”