Ten myths and misconceptions regarding pain management in the ICU

Critical Care Medicine

Volumn 43, Issue 11, 2015, Pages 2468-2478

  Sigakis, Matthew J G ^a   Bittner, Edward A ^b  

^a UNIVERSITY OF MICHIGAN MEDICAL SCHOOL   (United States)

^b MASSACHUSETTS GENERAL HOSPITAL   (United States)

Author keywords

Analgesia; Analgesics; Critical care; Pain assessment; Pain management; Quality improvement

Indexed keywords

ALPHA 2 ADRENERGIC RECEPTOR STIMULATING AGENT; ANALGESIC AGENT; ANTICONVULSIVE AGENT; BUPRENORPHINE; N METHYL DEXTRO ASPARTIC ACID RECEPTOR BLOCKING AGENT; NEFOPAM; NONSTEROID ANTIINFLAMMATORY AGENT; OPIATE; PARACETAMOL; NARCOTIC ANALGESIC AGENT;

ANALGESIA; ARTICLE; CLINICAL PRACTICE; CRITICAL ILLNESS; CRITICALLY ILL PATIENT; DATA BASE; HUMAN; INTENSIVE CARE UNIT; MAXIMUM PERMISSIBLE DOSE; MEDLINE; MUSIC THERAPY; NEUROPATHIC PAIN; NURSE; OUTCOME ASSESSMENT; PAIN; PAIN ASSESSMENT; PRIORITY JOURNAL; RELAXATION TRAINING; RESPONSIBILITY; SCIENTIFIC LITERATURE; SEDATION; SURVIVOR; ACUTE PAIN; DRUG EFFECTS; FEMALE; MALE; NEEDS ASSESSMENT; PAIN MEASUREMENT; PAIN THRESHOLD; PROCEDURES; PSYCHOLOGY; RISK ASSESSMENT; THERAPEUTIC MISCONCEPTION; TREATMENT OUTCOME;

ACUTE PAIN; ANALGESICS; ANALGESICS, OPIOID; CRITICAL ILLNESS; FEMALE; HUMANS; INTENSIVE CARE UNITS; MALE; NEEDS ASSESSMENT; PAIN MANAGEMENT; PAIN MEASUREMENT; PAIN THRESHOLD; RISK ASSESSMENT; THERAPEUTIC MISCONCEPTION; TREATMENT OUTCOME;

EID: 84944474793     PISSN: 00903493     EISSN: 15300293     Source Type: Journal    
DOI: 10.1097/CCM.0000000000001256     Document Type: Article

References (118)

1. Peitz GJ, Balas MC, Olsen KM, et al: Top 10 myths regarding sedation and delirium in the ICU. Crit Care Med 2013; 41:S46-S56
2. Stanik-Hutt JA, Soeken KL, Belcher AE, et al: Pain experiences of traumatically injured patients in a critical care setting. Am J Crit Care 2001; 10:252-259
3. Puntillo KA, Wild LR, Morris AB, et al: Practices and predictors of analgesic interventions for adults undergoing painful procedures. Am J Crit Care 2002; 11:415-429; quiz 430-431
4. Chanques G, Sebbane M, Barbotte E, et al: A prospective study of pain at rest: Incidence and characteristics of an unrecognized symptom in surgical and trauma versus medical intensive care unit patients. Anesthesiology 2007; 107:858-860
5. Grosclaude C, Asehnoune K, Demeure D, et al: [Opinion of different professional categories about the intensity of procedural pain in adult intensive care units]. Ann Fr Anesth Reanim 2010; 29:884-888
6. Novaes MA, Knobel E, Bork AM, et al: Stressors in ICU: Perception of the patient, relatives and health care team. Intensive Care Med 1999; 25:1421-1426
7. Pasero C, Puntillo K, Li D, et al: Structured approaches to pain management in the ICU. Chest 2009; 135:1665-1672
8. Tarigopula R, Tyagi NK, Jackson J, et al: Health care workers and ICU pain perceptions. Pain Med 2014; 15:1027-1035
9. Herr KA, Garand L: Assessment and measurement of pain in older adults. Clin Geriatr Med 2001; 17:457-478, vi
10. Erstad BL, Puntillo K, Gilbert HC, et al: Pain management principles in the critically ill. Chest 2009; 135:1075-1086
11. Cross SA: Pathophysiology of pain. Mayo Clin Proc 1994; 69:375-383
12. Lindenbaum L, Milia DJ: Pain management in the ICU. Surg Clin North Am 2012; 92:1621-1636
13. Akça O, Melischek M, Scheck T, et al: Postoperative pain and subcutaneous oxygen tension. Lancet 1999; 354:41-42
14. Lewis KS, Whipple JK, Michael KA, et al: Effect of analgesic treatment on the physiological consequences of acute pain. Am J Hosp Pharm 1994; 51:1539-1554
15. Rittner HL, Machelska H, Stein C: Leukocytes in the regulation of pain and analgesia. J Leukoc Biol 2005; 78:1215-1222
16. Kyranou M, Puntillo K: The transition from acute to chronic pain: Might intensive care unit patients be at risk? Ann Intensive Care 2012; 2:36
17. Granja C, Lopes A, Moreira S, et al; JMIP Study Group: Patients' recollections of experiences in the intensive care unit may affect their quality of life. Crit Care 2005; 9:R96-R109
18. Myhren H, Ekeberg O, Tøien K, et al: Posttraumatic stress, anxiety and depression symptoms in patients during the frst year post intensive care unit discharge. Crit Care 2010; 14:R14
19. Lee YC, Lu B, Edwards RR, et al: The role of sleep problems in central pain processing in rheumatoid arthritis. Arthritis Rheum 2013; 65:59-68
20. Chanques G, Jaber S, Barbotte E, et al: Impact of systematic evaluation of pain and agitation in an intensive care unit. Crit Care Med 2006; 34:1691-1699
21. Payen JF, Bosson JL, Chanques G, et al; DOLOREA Investigators: Pain assessment is associated with decreased duration of mechanical ventilation in the intensive care unit: A post hoc analysis of the DOLOREA study. Anesthesiology 2009; 111:1308-1316
22. Robinson BR, Mueller EW, Henson K, et al: An analgesia-delirium-sedation protocol for critically ill trauma patients reduces ventilator days and hospital length of stay. J Trauma 2008; 65:51 7-526
23. Payen JF, Bru O, Bosson JL, et al: Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med 2001; 29:2258-2263
24. Skrobik Y, Ahern S, Leblanc M, et al: Protocolized intensive care unit management of analgesia, sedation, and delirium improves analgesia and subsyndromal delirium rates. Anesth Analg 2010; 111:451-463
25. Awissi DK, Bégin C, Moisan J, et al: I-SAVE study: Impact of sedation, analgesia, and delirium protocols evaluated in the intensive care unit: An economic evaluation. Ann Pharmacother 2012; 46:21-28
26. Lattermann R, Belohlavek G, Wittmann S, et al: The anticatabolic effect of neuraxial blockade after hip surgery. Anesth Analg 2005; 101:1202-1208, table of contents
27. Ahlers O, Nachtigall I, Lenze J, et al: Intraoperative thoracic epidural anaesthesia attenuates stress-induced immunosuppression in patients undergoing major abdominal surgery. Br J Anaesth 2008; 101:781-787
28. Puntillo KA, Miaskowski C, Kehrle K, et al: Relationship between behavioral and physiological indicators of pain, critical care patients' self-reports of pain, and opioid administration. Crit Care Med 1997; 25:1159-1166
29. Ahlers SJ, van Gulik L, van der Veen AM, et al: Comparison of different pain scoring systems in critically ill patients in a general ICU. Crit Care 2008; 12:R15
30. Puntillo K, Pasero C, Li D, et al: Evaluation of pain in ICU patients. Chest 2009; 135:1069-1074
31. Chanques G, Viel E, Constantin JM, et al: The measurement of pain in intensive care unit: Comparison of 5 self-report intensity scales. Pain 2010; 151:711-721
32. Rose L, Smith O, Gelinas C, et al: Canadian critical care nurses' pain assessment and management practices: A national survey. Am J Crit Care 2012; 21:247-255
33. Gélinas C, Tousignant-Lafamme Y, Tanguay A, et al: Exploring the validity of the bispectral index, the critical-care pain observation tool and vital signs for the detection of pain in sedated and mechanically ventilated critically ill adults: A pilot study. Intensive Crit Care Nurs 2011; 27:46-52
34. Arbour C, Gélinas C: Are vital signs valid indicators for the assessment of pain in postoperative cardiac surgery ICU adults? Intensive Crit Care Nurs 2010; 26:83-90
35. Gélinas C, Fillion L, Puntillo KA, et al: Validation of the critical-care pain observation tool in adult patients. Am J Crit Care 2006; 15:420-427
36. Chanques G, Payen JF, Mercier G, et al: Assessing pain in non-intubated critically ill patients unable to self report: An adaptation of the Behavioral Pain Scale. Intensive Care Med 2009; 35:2060-2067
37. Gélinas C, Puntillo KA, Joffe AM, et al: A validated approach to evaluating psychometric properties of pain assessment tools for use in nonverbal critically ill adults. Semin Respir Crit Care Med 2013; 34:153-168
38. Chanques G, Pohlman A, Kress JP, et al: Psychometric comparison of three behavioural scales for the assessment of pain in critically ill patients unable to self-report. Crit Care 2014; 18:R160
39. Barr J, Fraser GL, Puntillo K, et al; American College of Critical Care Medicine: Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013; 41:263-306
40. Stites M: Observational pain scales in critically ill adults. Crit Care Nurse 2013; 33:68-78
41. Odhner M, Wegman D, Freeland N, et al: Assessing pain control in nonverbal critically ill adults. Dimens Crit Care Nurs 2003; 22:260-267
42. Voepel-Lewis T, Zanotti J, Dammeyer JA, et al: Reliability and validity of the face, legs, activity, cry, consolability behavioral tool in assessing acute pain in critically ill patients. Am J Crit Care 2010; 19:55-61; quiz 62
43. Topolovec-Vranic J, Canzian S, Innis J, et al: Patient satisfaction and documentation of pain assessments and management after implementing the adult nonverbal pain scale. Am J Crit Care 2010; 19:345-354; quiz 355
44. Marmo L, Fowler S: Pain assessment tool in the critically ill post-open heart surgery patient population. Pain Manag Nurs 2010; 11:134-140
45. Topolovec-Vranic J, Gelinas C, Li Y, et al: Validation and evaluation of two observational pain assessment tools in a trauma and neurosurgical intensive care unit. Pain Res Manag 2013; 18:e107-e114
46. Azzam PN, Alam A: Pain in the ICU: A psychiatric perspective. J Intensive Care Med 2013; 28:140-150
47. Desbiens NA, Mueller-Rizner N: How well do surrogates assess the pain of seriously ill patients? Crit Care Med 2000; 28:1347-1352
48. Wibbenmeyer L, Sevier A, Liao J, et al: Evaluation of the usefulness of two established pain assessment tools in a burn population. J Burn Care Res 2011; 32:52-60
49. Sessler CN: Progress toward eliminating inadequately managed pain in the ICU through interdisciplinary care. Chest 2009; 135:894-896
50. Gordon DB, Dahl JL, Miaskowski C, et al: American Pain Society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force. Arch Intern Med 2005; 165:1574-1580
51. Upp J, Kent M, Tighe PJ: The evolution and practice of acute pain medicine. Pain Med 2013; 14:124-144
52. Erdek MA, Pronovost PJ: Improving assessment and treatment of pain in the critically ill. Int J Qual Health Care 2004; 16:59-64
53. de Jong A, Molinari N, de Lattre S, et al: Decreasing severe pain and serious adverse events while moving intensive care unit patients: A prospective interventional study (the NURSE-DO project). Crit Care 2013; 17:R74
54. Berwick DM: Developing and testing changes in delivery of care. Ann Intern Med 1998; 128:651-656
55. Benyamin R, Trescot AM, Datta S, et al: Opioid complications and side effects. Pain Physician 2008; 11:S105-S120
56. Nseir S, Hoel J, Grailles G, et al: Remifentanil discontinuation and subsequent intensive care unit-acquired infection: A cohort study. Crit Care 2009; 13:R60
57. Chang G, Chen L, Mao J: Opioid tolerance and hyperalgesia. Med Clin North Am 2007; 91:199-211
58. Lee M, Silverman SM, Hansen H, et al: A comprehensive review of opioid-induced hyperalgesia. Pain Physician 2011; 14:145-161
59. Malchow RJ, Black IH: The evolution of pain management in the critically ill trauma patient: Emerging concepts from the global war on terrorism. Crit Care Med 2008; 36:S346-S357
60. Dahl JB, Kehlet H: Preventive analgesia. Curr Opin Anaesthesiol 2011; 24:331-338
61. Payen JF, Genty C, Mimoz O, et al: Prescribing nonopioids in mechanically ventilated critically ill patients. J Crit Care 2013; 28: 534.e7-534.e12
62. Ramaswamy S, Wilson JA, Lesley Colvin L. Non-opioid-based adjuvant analgesia in perioperative care. Cont Educ Anaesth Crit Care Pain 2013; 13:152-157
63. Phillips K, Clauw DJ: Central pain mechanisms in the rheumatic diseases: Future directions. Arthritis Rheum 2013; 65:291-302
64. Chanques G, Sebbane M, Constantin JM, et al: Analgesic effcacy and haemodynamic effects of nefopam in critically ill patients. Br J Anaesth 2011; 106:336-343
65. Hebl JR, Niesen AD: Infectious complications of regional anesthesia. Curr Opin Anaesthesiol 2011; 24:573-580
66. Stundner O, Memtsoudis SG: Regional anesthesia and analgesia in critically ill patients: A systematic review. Reg Anesth Pain Med 2012; 37:537-544
67. Capdevila X, Pirat P, Bringuier S, et al; French Study Group on Continuous Peripheral Nerve Blocks: Continuous peripheral nerve blocks in hospital wards after orthopedic surgery: A multi-center prospective analysis of the quality of postoperative analgesia and complications in 1, 416 patients. Anesthesiology 2005; 103:1035-1045
68. Madsen MV, Gøtzsche PC, Hróbjartsson A: Acupuncture treatment for pain: Systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. BMJ 2009; 338:a3115
69. Gorji HM, Nesami BM, Ayyasi M, et al: Comparison of ice packs application and relaxation therapy in pain reduction during chest tube removal following cardiac surgery. N Am J Med Sci 2014; 6:19-24
70. Gélinas C, Arbour C, Michaud C, et al: Patients and ICU nurses' perspectives of non-pharmacological interventions for pain management. Nurs Crit Care 2013; 18:307-318
71. Friesner SA, Curry DM, Moddeman GR: Comparison of two pain-management strategies during chest tube removal: Relaxation exercise with opioids and opioids alone. Heart Lung 2006; 35:269-276
72. Cepeda MS, Carr DB, Lau J, et al: Music for pain relief. Cochrane Database Syst Rev 2006; 2:CD004843
73. Cohen SP, Christo PJ, Wang S, et al: The effect of opioid dose and treatment duration on the perception of a painful standardized clinical stimulus. Reg Anesth Pain Med 2008; 33:199-206
74. Doverty M, Somogyi AA, White JM, et al: Methadone maintenance patients are cross-tolerant to the antinociceptive effects of morphine. Pain 2001; 93:155-163
75. Nalamachu SR: Opioid rotation in clinical practice. Adv Ther 2012; 29:849-863
76. Mitra S, Sinatra RS: Perioperative management of acute pain in the opioid-dependent patient. Anesthesiology 2004; 101:212-227
77. Alford DP, Compton P, Samet JH: Acute pain management for patients receiving maintenance methadone or buprenorphine therapy. Ann Intern Med 2006; 144:127-134
78. Fine PG, Portenoy RK; Ad Hoc Expert Panel on Evidence Review and Guidelines for Opioid Rotation: Establishing "best practices" for opioid rotation: Conclusions of an expert panel. J Pain Symptom Manage 2009; 38:418-425
79. Silverman SM: Opioid induced hyperalgesia: Clinical implications for the pain practitioner. Pain Physician 2009; 12:679-684
80. Mehta V, Langford RM: Acute pain management for opioid dependent patients. Anaesthesia 2006; 61:269-276
81. Prommer E: Rotating methadone to other opioids: A lesson in the mechanisms of opioid tolerance and opioid-induced pain. J Palliat Med 2006; 9:488-493
82. De Pinto M, Jelacic J, Edwards WT: Very-low-dose ketamine for the management of pain and sedation in the ICU. J Opioid Manag 2008; 4:54-56
83. Wunsch H, Kahn JM, Kramer AA, et al: Use of intravenous infusion sedation among mechanically ventilated patients in the United States. Crit Care Med 2009; 37:3031-3039
84. Jackson DL, Proudfoot CW, Cann KF, et al: The incidence of sub-optimal sedation in the ICU: A systematic review. Crit Care 2009; 13:R204
85. Payen JF, Chanques G, Mantz J, et al: Current practices in sedation and analgesia for mechanically ventilated critically ill patients: A prospective multicenter patient-based study. Anesthesiology 2007; 106:687-695; quiz 891-892
86. Devabhakthuni S, Armahizer MJ, Dasta JF, et al: Analgosedation: A paradigm shift in intensive care unit sedation practice. Ann Pharmacother 2012; 46:530-540
87. Karabinis A, Mandragos K, Stergiopoulos S, et al: Safety and effcacy of analgesia-based sedation with remifentanil versus standard hypnotic based regimens in intensive care unit patients with brain injuries: A randomised, controlled trial. Crit Care 2004; 8:R268-R280
88. Breen D, Karabinis A, Malbrain M, et al: Decreased duration of mechanical ventilation when comparing analgesia-based sedation using remifentanil with standard hypnotic-based sedation for up to 10 days in intensive care unit patients: A randomised trial [ISRCTN47583497]. Crit Care 2005; 9:R200-R210
89. Wilhelm W, Kreuer S: The place for short-acting opioids: Special emphasis on remifentanil. Crit Care 2008; 12(Suppl 3):S5
90. Kim SH, Stoicea N, Soghomonyan S, et al: Intraoperative use of remifentanil and opioid induced hyperalgesia/acute opioid tolerance: Systematic review. Front Pharmacol 2014; 5:108
91. Tedders KM, McNorton KN, Edwin SB: Effcacy and safety of analgosedation with fentanyl compared with traditional sedation with pro-pofol. Pharmacotherapy 2014; 34:643-647
92. Strøm T, Martinussen T, Toft P: A protocol of no sedation for critically ill patients receiving mechanical ventilation: A randomised trial. Lancet 2010; 375:475-480
93. Park G, Lane M, Rogers S, et al: A comparison of hypnotic and analgesic based sedation in a general intensive care unit. Br J Anaesth 2007; 98:76-82
94. Rozendaal FW, Spronk PE, Snellen FF, et al; UltiSAFE Investigators: Remifentanil-propofol analgo-sedation shortens duration of ventilation and length of ICU stay compared to a conventional regimen: A centre randomised, cross-over, open-label study in the Netherlands. Intensive Care Med2009; 35:291-298
95. Strøm T, Stylsvig M, Toft P: Long-term psychological effects of a no-sedation protocol in critically ill patients. Crit Care 2011; 15:R293
96. Puntillo KA, Max A, Timsit JF, et al: Determinants of procedural pain intensity in the intensive care unit. The Europain® study. Am J Respir Crit Care Med 2014; 189:39-47
97. Puntillo K, Ley SJ: Appropriately timed analgesics control pain due to chest tube removal. Am J Crit Care 2004; 13:292-301; discussion 302; quiz 303-304
98. Yiannakopoulos CK, Kanellopoulos AD: Innoxious removal of suction drains. Orthopedics 2004; 27:412-414
99. Lightowler JV, Elliott MW: Local anaesthetic infltration prior to arterial puncture for blood gas analysis: A survey of current practice and a randomised double blind placebo controlled trial. J R Coll Physicians Lond 1997; 31:645-646
100. Faigeles B, Howie-Esquivel J, Miaskowski C, et al: Predictors and use of nonpharmacologic interventions for procedural pain associated with turning among hospitalized adults. Pain Manag Nurs 2013; 14:85-93
101. Pisani MA: Considerations in caring for the critically ill older patient. J Intensive Care Med 2009; 24:83-95
102. Rosenthal RA, Kavic SM: Assessment and management of the geriatric patient. Crit Care Med 2004; 32:S92-S105
103. Gibson SJ: Progress in pain research and management. In: Proceedings of the 10th World Congress on Pain. Vol. 24. Dostrovsky JO, Carr DB, Kaltenzburg M (Eds). Seattle, WA, IASP Press, 2003, pp 767-790
104. McCleane G: Pharmacological pain management in the elderly patient. Clin Interv Aging 2007; 2:637-643
105. Lautenbacher S, Kunz M, Strate P, et al: Age effects on pain thresholds, temporal summation and spatial summation of heat and pressure pain. Pain 2005; 115:410-418
106. Hadjistavropoulos T, Herr K, Turk DC, et al: An interdisciplinary expert consensus statement on assessment of pain in older persons. Clin J Pain 2007; 23:S1-S43
107. Hofand SL: Elder beliefs: Blocks to pain management. J Gerontol Nurs 1992; 18:19-23
108. Portenoy RK, Farkash A: Practical management of non-malignant pain in the elderly. Geriatrics 1988; 43:29-40, 44-47
109. Coldrey JC, Upton RN, Macintyre PE: Advances in analgesia in the older patient. Best Pract Res Clin Anaesthesiol 2011; 25:367-378
110. Bontin-Mushock C, Philip L, Moriyama K, et al: Age dependent opioid escalation in chronic pain patients. Anesth Analg 2005; 100:1740-1745
111. Schelling G, Stoll C, Haller M, et al: Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med 1998; 26:651-659
112. Voscopoulos C, Lema M: When does acute pain become chronic? Br J Anaesth 2010; 105(Suppl 1):i69-i85
113. Adler J, Malone D: Early mobilization in the intensive care unit: A systematic review. Cardiopulm Phys Ther J 2012; 23:5-13
114. García Lizana F, Peres Bota D, De Cubber M, et al: Long-term outcome in ICU patients: What about quality of life? Intensive Care Med 2003; 29:1286-1293
115. Dowdy DW, Eid MP, Dennison CR, et al: Quality of life after acute respiratory distress syndrome: A meta-analysis. Intensive Care Med 2006; 32:1115-1124
116. Zimmer A, Rothaug J, Mescha S, et al: Chronic pain after surviving sepsis. Crit Care 2006; 10:421
117. Battle CE, Lovett S, Hutchings H: Chronic pain in survivors of critical illness: A retrospective analysis of incidence and risk factors. Crit Care 2013; 17:R101
118. Perkins FM, Kehlet H: Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology 2000; 93:1123-1133