Pain Requires Meticulous Attention in Intensive Care Units

Two reviews address the challenges of evaluating and managing pain in critically ill patients
By Rick Ansorge
HealthDay Reporter

MONDAY, April 13 (HealthDay News) -- In intensive care units, the evaluation and management of pain is a significant clinical challenge, according to two Contemporary Reviews in Critical Care Medicine published in the April issue of the journal Chest.

In the first review, Kathleen Puntillo, of the University of California San Francisco, and colleagues address the evaluation of pain in intensive care unit (ICU) patients. They point out that only two pain behavior instruments -- the pain behavior scale and the Critical-Care Pain Observation Tool -- have been rigorously tested for use in ICUs. But they also discuss other less-validated tools such as the pain assessment, intervention, and notation (PAIN) algorithm, and a pain behaviors checklist. They write that when established tools for evaluating pain are insufficient, alternative methods should be considered.

In a second review, Brian L. Erstad, of the University of Arizona College of Pharmacy in Tucson, and colleagues address the management of pain in critically ill ICU patients. They point out that opioids have been the mainstay of pain control. They also discuss other medications that have been proposed as alternatives or adjuncts to opioids as well as non-pharmacologic, complementary therapies. But they emphasize that neither of these approaches has been well-studied in the ICU setting.

"Due to the paucity of high-level evidence on which to base pharmacologic treatment decisions, regimens must be based on known physiochemical, pharmacokinetic and pharmacodynamic characteristics of the agents in conjunction with extrapolations of evidence from other patient populations and settings," Erstad and colleagues write.

Several authors from the studies have ties to various pharmaceutical companies.

Abstract - Puntillo
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Abstract - Erstad
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