Assessing Pain in Critically Ill Adults


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Scope and Impact of the Problem

Many critically ill adult patients experience significant pain as indicated by a score on a numeric rating scale greater than 4.1 Furthermore, more than 50% have significant pain during procedures or routine care (eg, chest tube removal, endotracheal suctioning, wound care, turning/repositioning).2,3Even a dressing change can cause pain.4

Untreated pain can result in negative consequences, including adverse events (eg, tachycardia/bradycardia, hypertension/hypotension, desaturation, bradypnea)5 and the development of chronic pain.6,7 Conversely, treating pain first, before sedative use (analgosedation) can significantly decrease pain scores, duration of mechanical ventilation, and length of stay in the intensive care unit (ICU).8

Because pain is multidimensional and subjective,9 the patient's self-report is the gold standard for assessment. However, many adult patients in the ICU cannot self-report pain as a result of an altered level of consciousness, mechanical ventilation, and/or the administration of sedative agents. The lack of self-reporting makes assessing pain in critically ill patients a challenge for nurses, who should consider use of alternatives such as behavioral pain assessment tools.1,10

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