Unrecognised, undertreated, pain in ICU—Causes, effects, and how to do better

Abstract

Methods: a literature review from 1990 to August 2012. Introduction: pain and its recognition can be a particular problem for patients in intensive care units (ICUs). Studies have suggested that around 70% of ICU patients have unrecognised or undertreated pain. Pain has serious physical and psychological effects, and can impair patient recovery and discharge. Pain relief is also an ethical and professional responsibility of doctors and nurses-and we may be failing in this. Causes: pain may be due to medical and nursing procedures, and the ICU environment. Pain can be under-recognised because ICU patients are often impaired in their ability to communicate (e.g. secondary to confusion from acute illness, endotracheal intubation, or reduced conscious level from sedative agents). Tools for pain assessment: in patients able to communicate verbally, the Numerical Rating Scale (NRS) can be used to rate pain severity. In non-verbal, conscious, patients, the Visual Analogue Scale (VAS) can be used as a visual alternative. Both are well-established. For unconscious/sedated patients, the Behavioural Pain Scale (BPS) and Critical Care Pain Observation Tool (CPOT) have been developed and validated. Changes in practice: where possible, sedation practice can be changed to allow better recognition of pain. Constant deep sedation can be interrupted with daily "sedation holds" to allow pain assessment. "Analgo-sedation" may also be used, with drug regimes which prioritise analgesia over sedation. "No-sedation" approaches may also be considered, but further research is required.

Vital signs: Valid indicators to assess pain in intensive care unit patients? An observational, descriptive study

“…A systematic assessment of pain is difficult, and pain can be under-recognized due to non-communicative patients being unable to self-report pain (e.g. being unconscious or mechanically ventilated) (Alderson & McKechnie, 2013;Puntillo et al, 2004). The literature reveals that systematic pain assessment has a pivotal role for minimizing pain and analgesic consumption (Erden, Demir, Kanatlı, Danacı, & Carbo ga, 2017).…”

Pain assessment of traumatic brain injury victims using the Brazilian version of the Behavioral Pain Scale

“…Although pain is an experience often associated with trauma, pain underestimation and undertreatment (oligoanalgesia) are constant phenomena among care teams. ( 13 , 14 ) Due to the severity of the condition and the association with multiple trauma, the situation becomes more worrisome in regard to victims of traumatic brain injury (TBI), as there are few studies related to this topic. ( 15 , 16 ) TBI is a serious public health problem that leads to disability, impaired quality of life and chronic pain.…”

Impact of a multifaceted and multidisciplinary intervention on pain, agitation and delirium management in a Canadian community intensive care unit: a quality improvement study protocol

“…2 Pain is a common symptom in the ICU; the incidence of moderate to severe pain is up to 50%-80%. [13][14][15] Agitation affects at least 71% of patients in the ICU. 16 The causes of pain, agitation and delirium (PAD) are multifactorial.…”