Comprehensive Pain Management Approach Needed in ICU


The journal Chest will be publishing a series of five papers that discuss the need for a comprehensive approach to assessing and managing pain in the ICU.

The journal Chest will publish a series of five papers that discuss the need for a comprehensive approach to assessing and managing pain in the ICU.

The first two papers in the series were published in the April 9th issue of Chest and are titled “Evaluation of Pain in the ICU” and “Pain Management Principles in the Critically Ill.” The series has been developed by critical care experts from the Critical Care Institute of the American College of Chest Physicians, the American Society of Health-System Pharmacists, and the American Association of Critical-Care Nurses.

The article series “reviews the complex nature of pain experienced by a critical care patient and details the benefits of taking a comprehensive approach to pain management one that combines pharmacotherapy with behavioral, social, and communication strategies, interdisciplinary teams, and family involvement.”

The critical care team often confronts a variety of pain management challenges, including caring for patients who are suffering from pain due to life-threatening illnesses or injuries, and effectively managing pain in critically ill patients who frequently have difficulty communicating their pain effectively to caregivers.

Because standard pain assessment tools may often be inadequate when employed in the treatment of critically ill patients, the report suggests the use of alternative pain assessment methods. These include:

  • Patient Risk Profile—This tool identifies the patient’s risk of pain prior to a procedure and allows the team to administer preemptive pain management, thereby decreasing the incidence of pain.
  • Nonverbal Communication—Patients who cannot speak or who have difficulty speaking may be able to point or blink when referring to a pain scale.
  • Analgesic Trial—To verify the presence of pain, the ICU team can administer a low dose of first-line analgesic followed by observation of the patient’s pain-related behaviors.
  • Surrogate Reporting—If patients are unable to communicate, the ICU team can use “surrogate reports” from family members who may be able assess a loved one’s pain based on history.


In addition to accurately assessing pain in this patient population, the care team must also provide effective pain management, for which information is mostly unavailable.

Lead author Brian L. Erstad, PharmD, FCCM, explained in a news release that “Much of the research on pain medications has been conducted in non-ICU settings. The ICU clinician must extrapolate and apply this research to the care of critically ill patients who frequently have tenuous and rapidly changing clinical conditions that complicate pharmacotherapy decisions.”

The full-text versions of both articles are available free of charge here.

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