Assessing pain in critically ill adults
Jennifer Surprise MSN, APRN, RN-BC, ACNS-BC

Nursing2015 Critical Care
July 2014 
Volume 9  Number 4
Pages 36 - 41
  PDF Version Available!

Pain is a frequent source of stress in the ICU and is experienced by nearly all critically ill patients during their stay.1 Inadequate recognition and management of pain is associated with an increased risk of hemodynamic instability, hyperglycemia, alterations in immune system functioning, and release of catecholamines, cortisol, and antidiuretic hormone.2In addition, it's possible for untreated acute pain to produce neurohumoral changes, neuronal remodeling, and long-lasting psychological and emotional stress, which may lead to prolonged chronic pain states.3 Yet, the under treatment of pain is common in the ICUs due to lack of recognition and concerns about the adverse effects of medications (respiratory depression and hemodynamic compromise).4 This is especially troubling as pain and anxiety in the critically ill are inextricably linked, with both contributing to poor outcomes in the critically ill patient.The recent DOLOREA study highlighted the importance of pain management in the ICU by demonstrating a reduction in the use of hypnotics, midazolam, duration of mechanical ventilation, and ICU length of stay with a standardized assessment of pain.5The assessment and treatment of pain is mandated by multiple regulatory bodies including The Joint Commission, and the Centers for Medicare and Medicaid Services, and is now a publically reported quality measure.6,7 In addition, multiple best practice organizations, including the American Society for Pain Management Nursing (ASPMN), the Society for Critical Care Medicine (SCCM), and the American Association of Critical Care Nurses (AACN), have developed guidelines to arm nurses with the information needed to perform an evidence-based approach to pain management in the critically ill (see The pathophysiology of acute pain).8-10 The purpose of this article is to summarize the most recent evidence on the assessment of pain in the critically ill adult and provide specific clinical practice recommendations for critical care

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