One of the greatest stressors and most
common symptoms in critically ill
patients.
Pain
Is a complex, subjective phenomenon
(can be directly known).
Pain
It is a protective mechanism, causing one
either to withdraw from or to avoid the
source
Pain
An unpleasant sensory and emotional
experience with actual or potential tissue
damage.
Pain
Types of Pain (2)
Based on duration
Based on source
Types of Pain
- Based on duration (2)
Acute pain
Chronic pain
Types of Pain
- Based on source (3)
Somatic
Visceral
Nerve
Factors Contributing to Pain (3)
PHYSICAL
PSYCHOSOCIAL
INTENSIVE CARE UNIT ENVIRONMENT OR
ROUTINE
Factors Contributing to Pain
- PHYSICAL (5)
• Symptoms of critical illness (eg, angina,
ischemia, dyspnea)
• Wounds: post-trauma, post-operative,
post-procedural or penetrating tubes and
catheters
• Sleep disturbance and deprivation
• Immobility; inability to move to a
comfortable position
• Temperature extremes
Factors Contributing to Pain
- PSYCHOSOCIAL (6)
• Anxiety and depression
• Impaired communication; inability to report
and describe pain
• Fear of pain, disability or death
• Separation from family and significant
others
• Boredom or lack of pleasant distractions
• Sleep deprivation, delirium or altered
sensorium
Factors Contributing to Pain
- INTENSIVE CARE UNIT ENVIRONMENT OR
ROUTINE (5)
• Noise from equipment and staff
• Unnatural patters of light
• Awakening and physical manipulation
every 1 – 2 hours for vital signs or
positioning.
• Frequent invasive or painful procedures
• Competing priorities in care
Procedural Pain in Intensive Care
- Based on research the following are common
source of procedural pain in the ICU: (5)
• Position changes
• Tracheal suctioning
• Deep breathing and coughing exercise
• Dressing changes
• Drain removal
Barriers to Effective Pain Control (3)
TOLERANCE
DEPENDENCE
ADDICTION
Barriers to Effective Pain Control
- a state of adaption in which
exposure to a drug induces changes that result in
a diminution of one or more drug’s effect over time.
TOLERANCE
Barriers to Effective Pain Control
- can be produced by abrupt
cessation, rapid dose reduction, decreasing blood
level of the drug or administration of antagonist.
DEPENDENCE
Barriers to Effective Pain Control
- characterized by behaviors that
include one or more of the following:
• impaired control over drug use
• compulsive use
• continued use despite harm
• craving
ADDICTION
Clinical Practice Guidelines
- These guidelines were intended to serve
_ of care for specific
clinical problems.
nationwide standards
Clinical Practice Guidelines
- _ was the topic of the first
guideline and now there are over 2,500
practice guidelines on the _.
Acute pain
National
Guideline Clearinghouse
Clinical Practice Guidelines
- These guidelines are also used as _ representing the national
standard of care for pain management in
medical liability.
legal
documents
CPGs for the management of pain (2)
PALLIATIVE CARE
PAIN ASSESSMENT (Self-Report and Observation)
CPGs for the management of pain
- multidisciplinary approach
to improving the quality of life in persons with
serious or life-limiting illness based on open
communication, patient and family centered goals
and multidimensional and symptom management.
PALLIATIVE CARE
CPGs for the management of pain
- should be done
systematically and at regular intervals using
multiple sources of data.
PAIN ASSESSMENT
PAIN ASSESSMENT
- is considered the gold standard in
pain assessment. For patients able to self-report,
a numeric rating scale, in which the patient rates the pain on a scale of 1 to 10, with 10 being
severe pain, is most used
Self-Report
Observation
- Nonverbal behaviors (4)
guarding,
withdrawal, and avoidance of movement, protect
the patient from painful stimuli
