For patients admitted to intensive care, pain is a common experience with potentially significant consequences. Pain management needs to evolve from the traditional ‘one-size-fits-all’ plan to a more personalised approach. This can be achieved by appreciating the numerous potential causes of pain, using appropriate assessment tools, utilising a range of potential treatment options and addressing the challenges associated with pain management in this heterogeneous population. At this point a truly multimodal, multidisciplinary management plan can be implemented, aimed at improving pain control and ultimately patient outcomes.
PaseroCPuntilloKLiD. Structured approaches to pain management in the ICU. Chest2009;135: 1665–72.
2.
PayenJFChanquesGMantzJ. Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study. Anesthesiology2007;106: 687–695; quiz 891-2.
3.
SolimanHMMelotCVincentJL. Sedative and analgesic practice in the intensive care unit: the results of a European survey. Br J Anaesth2001;87: 186–92.
4.
WoienHStubhaugABjorkIT. Analgesia and sedation of mechanically ventilated patients - a national survey of clinical practice. Acta Anaesthesiol Scand2012;56: 23–29.
5.
GelinasCFortierMViensCFillionLPuntilloK. Pain assessment and management in critically ill intubated patients: a retrospective study. Am J Crit Care2004;13: 126–35.
6.
MerskeyHBogdukN. Part III: Pain Terms, A Current List with Definitions and Notes on Usage: In: MerskyHBogdukN, eds, Classification of Chronic Pain. IASP Task Force on Taxonomy. Second Edition. Seattle: IASP Press; 1994.209–14.
7.
DesbiensNAWuAWBrosteSK. Pain and satisfaction with pain control in seriously ill hospitalized adults: findings from the SUPPORT research investigations. For the SUPPORT investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatmentm. Crit Care Med1996;24: 1953–61.
8.
ChanquesGJaberSBarbotteE. Impact of systematic evaluation of pain and agitation in an intensive care unit. Crit Care Med2006;34: 1691–99.
9.
ChanquesGSebbaneMBarbotteE. A prospective study of pain at rest: incidence and characteristics of an unrecognized symptom in surgical and trauma versus medical intensive care unit patients. Anesthesiology2007;107: 858–60.
10.
MillerDBO'CallaghanJP. Neuroendocrine aspects of the response to stress. Metabolism2002;51 (6 Suppl 1):5–10.
11.
CuestaJMSingerM. The stress response and critical illness: A review. Crit Care Med2012;40: 3283–89.
12.
BreslowMJParkerSDFrankSM. Determinants of catecholamine and cortisol responses to lower extremity revascularization. The PIRAT Study Group. Anesthesiology1993;79: 1202–09.
13.
GreisenJJuhlCBGrofteT. Acute pain induces insulin resistance in humans. Anesthesiology2001;95: 578–84.
14.
TsujiHShirasakaCAsohTUchidaI. Effects of epidural administration of local anaesthetics or morphine on postoperative nitrogen loss and catabolic hormones. Br J Surg1987;74: 421–25.
15.
WasylakTJAbbottFVEnglishMJJeansME. Reduction of postoperative morbidity following patient-controlled morphine. Can J Anaesth1990;37: 726–31.
16.
KehletH. Surgical stress: the role of pain and analgesia. Br J Anaesth1989;63: 189–95.
RiggJRJamrozikKMylesPS. Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet2002;359: 1276–82.
19.
NishimoriMLowJHZhengHBallantyneJC. Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev2012;7: CD005059.
20.
MoonMRLuchetteFAGibsonSW. Prospective, randomized comparison of epidural versus parenteral opioid analgesia in thoracic trauma. Ann Surg1999;229: 684–91; discussion 691–92.
21.
PayenJFBossonJLChanquesG. Pain assessment is associated with decreased duration of mechanical ventilation in the intensive care unit: a post hoc analysis of the DOLOREA study. Anesthesiology2009;111: 1308–16.
22.
AkcaOMelischekMScheckT. Postoperative pain and subcutaneous oxygen tension. Lancet1999;354: 41–42.
23.
HopfHWHuntTKWestJM. Wound tissue oxygen tension predicts the risk of wound infection in surgical patients. Arch Surg1997;132: 997–1004; discussion 1005.
24.
EveringhamK SSLapinlampiP. Agitation and pain during physiotherapy in intensive care. Crit Care2010;14 Suppl 1:492.
25.
JackKMcLeanSMMoffettJKGardinerE. Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Man Ther2010;15: 220–28.
26.
TruongADFanEBrowerRGNeedhamDM. Bench-to-bedside review: mobilizing patients in the intensive care unit—from pathophysiology to clinical trials. Crit Care2009;13: 216.
27.
NelsonJEMeierDELitkeA. The symptom burden of chronic critical illness. Crit Care Med2004;32: 1527–34.
28.
SchellingGStollCHallerM. Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med1998;26: 651–59.
29.
SiddallPJCousinsMJ. Persistent pain as a disease entity: implications for clinical management. Anesth Analg2004;99: 510–20.
30.
BoyleMMurgoMAdamsonH. The effect of chronic pain on health related quality of life amongst intensive care survivors. Aust Crit Care.2004;17: 104–06, 108–13.
31.
LizanaF GarciaBotaD PeresDe CubberMVincentJL. Long-term outcome in ICU patients: what about quality of life?Intensive Care Med2003;29: 1286–93.
32.
HolmesAWilliamsonOHoggM. Predictors of pain 12 months after serious injury. Pain Med2010;11: 1599–611.
PoleshuckELKatzJAndrusCH. Risk factors for chronic pain following breast cancer surgery: a prospective study. J Pain2006;7: 626–34.
35.
NikolajsenLBrandsborgBLuchtU. Chronic pain following total hip arthroplasty: a nationwide questionnaire study. Acta Anaesthesiol Scand2006;50: 495–500.
36.
Lavand'HommeP. The progression from acute to chronic pain. Curr Opin Anaesthesiol2011;24: 545–50.
37.
NovaesMAKnobelEBorkAM. Stressors in ICU: perception of the patient, relatives and health care team. Intensive Care Med1999;25: 1421–26.
38.
GranjaCLopesAMoreiraS. Patients' recollections of experiences in the intensive care unit may affect their quality of life. Crit Care2005;9: R96–109.
39.
MyhrenHEkebergOToienK. Posttraumatic stress, anxiety and depression symptoms in patients during the first year post intensive care unit discharge. Crit Care2010;14: R14.
40.
JacobiJFraserGLCoursinDB. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med2002;30: 119–41.
41.
BrennanFCarrDBCousinsM. Pain management: a fundamental human right. Anesth Analg2007;105: 205–21.
42.
BeauchampTLChildressJF. Principles of Biomedical Ethics.New York: Oxford University Press; 1979.
43.
BeauchampT. Chapter 1. In: AshcroftAdreDraperHMcMillanJR, eds. Principles of Health Care Ethics.2nd ed.Chichester, England: John Wiley & Sons; 2007.
44.
CousinsMJBrennanFCarrDB. Pain relief: a universal human right. Pain2004;112: 1–4.
45.
BrowerRG. Consequences of bed rest. Crit Care Med2009;37(10 Suppl):S422–428.
46.
PieperBLangemoDCuddiganJ. Pressure ulcer pain: a systematic literature review and national pressure ulcer advisory panel white paper. Ostomy Wound Manage2009;55: 16–31.
47.
RotondiAJChelluriLSirioC. Patients' recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit. Crit Care Med2002;30: 746–52.
48.
GacouinACamusCLe TulzoY. Assessment of peri-extubation pain by visual analogue scale in the adult intensive care unit: a prospective observational study. Intensive Care Med2004;30: 1340–47.
49.
PuntilloKAWhiteCMorrisAB. Patients' perceptions and responses to procedural pain: results from Thunder Project II. Am J Crit Care.2001;10: 238–51.
50.
PuntilloKAWildLRMorrisAB. Practices and predictors of analgesic interventions for adults undergoing painful procedures. Am J Crit Care2002;11: 415–29; quiz 430–31.
51.
KumarABBrennanTJ. Pain assessment, sedation, and analgesic administration in the intensive care unit. Anesthesiology2009;111: 1187–88.
52.
PuntilloKAMiaskowskiCKehrleK. Relationship between behavioral and physiological indicators of pain, critical care patients' self-reports of pain, and opioid administration. Crit Care Med1997;25: 1159–66.
53.
AhlersSJvan GulikLvan der VeenAM. Comparison of different pain scoring systems in critically ill patients in a general ICU. Crit Care2008;12: R15.
54.
TurkDCMelzackR. The measurement of pain and the assessment of people experiencing pain. Handbook of Pain Assessment. 2nd.New York; London: Guilford Press; 2001.
55.
BagchiAK. Pain and language. Acta Neurochir Suppl (Wien).1987;38: 182–84.
56.
ChanquesGVielEConstantinJM. The measurement of pain in intensive care unit: comparison of 5 self-report intensity scales. Pain2010;151: 711–21.
57.
PuntilloKPaseroCLiD. Evaluation of pain in ICU patients. Chest2009;135: 1069–74.
58.
MelzackR. The short-form McGill Pain Questionnaire. Pain1987;30: 191–97.
59.
DautRLCleelandCSFlaneryRC. Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases. Pain1983;17: 197–210.
60.
PayenJFBruOBossonJL. Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med2001;29: 2258–63.
61.
ChanquesGPayenJFMercierG. Assessing pain in non-intubated critically ill patients unable to self report: an adaptation of the Behavioral Pain Scale. Intensive Care Med2009;35: 2060–67.
62.
GelinasCFillionLPuntilloKA. Validation of the critical-care pain observation tool in adult patients. Am J Crit Care2006;15: 420–27.
63.
PuntilloKAMorrisABThompsonCL. Pain behaviors observed during six common procedures: results from Thunder Project II. Crit Care Med2004;32: 421–27.
64.
OdhnerMWegmanDFreelandN. Assessing pain control in nonverbal critically ill adults. Dimens Crit Care Nurs2003;22: 260–67.
65.
LiDPuntilloKMiaskowskiC. A review of objective pain measures for use with critical care adult patients unable to self-report. J Pain2008;9: 2–10.
66.
DesbiensNAMueller-RiznerN. How well do surrogates assess the pain of seriously ill patients?Crit Care Med2000;28: 1347–52.
67.
LerchCParkGR. Sedation and analgesia. Br Med Bull1999;55: 76–95.
68.
ParkGR. Molecular mechanisms of drug metabolism in the critically ill. Br J Anaesth1996;77: 32–49.
69.
ErstadBLPuntilloKGilbertHC. Pain management principles in the critically ill. Chest2009;135: 1075–86.
70.
KressJPPohlmanASO'ConnorMFHallJB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med2000;342: 1471–77.
71.
SchweickertWDGehlbachBKPohlmanAS. Daily interruption of sedative infusions and complications of critical illness in mechanically ventilated patients. Crit Care Med2004;32: 1272–76.
72.
SchweickertWDPohlmanMCPohlmanAS. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet2009;373: 1874–82.
73.
FreireAXAfessaBCawleyP. Characteristics associated with analgesia ordering in the intensive care unit and relationships with outcome. Crit Care Med2002;30: 2468–72.
74.
DahabaAAGrabnerTRehakPH. Remifentanil versus morphine analgesia and sedation for mechanically ventilated critically ill patients: a randomized double blind study. Anesthesiol2004;101: 640–46.
75.
CevikFCelikMClarkPMMacitC. Sedation and analgesia in intensive care: a comparison of fentanyl and remifentanil. Pain Res Treat2011;2011: 650320.
76.
YeagerMPGlassDDNeffRKBrinck-JohnsenT. Epidural anesthesia and analgesia in high-risk surgical patients. Anesthesiology1987;66: 729–36.
77.
DarchyBForcevilleXBavouxESoriotF. Clinical and bacteriologic survey of epidural analgesia in patients in the intensive care unit. Anesthesiol1996;85: 988–98.
78.
MelzackRWallPD. Pain mechanisms: a new theory. Science1965;150: 971–79.
79.
MadsenMVGotzschePCHrobjartssonA. Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. BMJ2009;338: a3115.
80.
FriesnerSACurryDMModdemanGR. Comparison of two pain-management strategies during chest tube removal: relaxation exercise with opioids and opioids alone. Heart Lung2006;35: 269–76.
81.
TusekDLCwynarRCosgroveDM. Effect of guided imagery on length of stay, pain and anxiety in cardiac surgery patients. J Cardiovasc Manag1999;10: 22–28.
82.
CepedaMSCarrDBLauJAlvarezH. Music for pain relief. Cochrane Database Syst Rev2006(2):CD004843.
83.
Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med2000;342: 1301–08.
84.
MarelichGPMurinSBattistellaF. Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses: effect on weaning time and incidence of ventilator-associated pneumonia. Chest2000;118: 459–67.
85.
RobinsonBRMuellerEWHensonK. An analgesia-delirium-sedation protocol for critically ill trauma patients reduces ventilator days and hospital length of stay. J Trauma2008;65: 517–26.
86.
SkrobikYAhernSLeblancM. Protocolized intensive care unit management of analgesia, sedation, and delirium improves analgesia and subsyndromal delirium rates. Anesth Analg2010;111: 451–63.
87.
ErdekMAPronovostPJ. Improving assessment and treatment of pain in the critically ill. Int J Qual Health Care2004;16: 59–64.
