4 research outputs found
Pain distress : the negative emotion associated with procedures in ICU patients
The intensity of procedural pain in intensive care unit (ICU) patients is well documented. However, little is known about procedural pain distress, the psychological response to pain. Post hoc analysis of a multicenter, multinational study of procedural pain. Pain distress was measured before and during procedures (0-10 numeric rating scale). Factors that influenced procedural pain distress were identified by multivariable analyses using a hierarchical model with ICU and country as random effects. A total of 4812 procedures were recorded (3851 patients, 192 ICUs, 28 countries). Pain distress scores were highest for endotracheal suctioning (ETS) and tracheal suctioning, chest tube removal (CTR), and wound drain removal (median [IQRs] = 4 [1.6, 1.7]). Significant relative risks (RR) for a higher degree of pain distress included certain procedures: turning (RR = 1.18), ETS (RR = 1.45), tracheal suctioning (RR = 1.38), CTR (RR = 1.39), wound drain removal (RR = 1.56), and arterial line insertion (RR = 1.41); certain pain behaviors (RR = 1.19-1.28); pre-procedural pain intensity (RR = 1.15); and use of opioids (RR = 1.15-1.22). Patient-related variables that significantly increased the odds of patients having higher procedural pain distress than pain intensity were pre-procedural pain intensity (odds ratio [OR] = 1.05); pre-hospital anxiety (OR = 1.76); receiving pethidine/meperidine (OR = 4.11); or receiving haloperidol (OR = 1.77) prior to the procedure. Procedural pain has both sensory and emotional dimensions. We found that, although procedural pain intensity (the sensory dimension) and distress (the emotional dimension) may closely covary, there are certain factors than can preferentially influence each of the dimensions. Clinicians are encouraged to appreciate the multidimensionality of pain when they perform procedures and use this knowledge to minimize the patient's pain experience.Peer reviewe
Determinants of procedural pain intensity in the intensive care unit: the Europain® study
Rationale:Intensive care unit (ICU) patients undergo several diagnostic
and therapeutic procedures every day. The prevalence, intensity, and risk
factors of pain related to these procedures are not well known.
Objectives: To assess self-reported procedural pain intensity versus
baseline pain, examine pain intensity differences across procedures,
and identify risk factors for procedural pain intensity.
Methods: Prospective, cross-sectional, multicenter, multinational
study of pain intensity associated with 12 procedures. Data were
obtained from 3,851 patients who underwent 4,812 procedures in 192
ICUs in 28 countries.
Measurements andMain Results: Painintensity on a 0–10 numeric
rating scale increased significantly from baseline pain during all
procedures (P , 0.001). Chest tube removal, wound drain removal, and
arterial line insertion were the three most painful procedures, with
median pain scores of 5 (3–7), 4.5 (2–7), and 4 (2–6), respectively. By
multivariate analysis, risk factors independently associated with greater
procedural pain intensity were the specific procedure; opioid
administration specifically for the procedure; preprocedural pain
intensity; preprocedural pain distress; intensity of the worst pain on the
same day, before the procedure; and procedure not performed by a nurse.
A significant ICU effect was observed, with no visible effect of country
because of its absorption by the ICU effect. Some of the risk factors
became nonsignificant when each procedure was examined separately. Conclusions: Knowledge of risk factors for greater procedural pain
intensity identified in this study may help clinicians select
interventions that are needed to minimize procedural pain.
Clinical trial registered with www.clinicaltrials.gov (NCT 01070082)