title: Analysis of pain management in critically ill patients.
abstract: We analyzed the adequacy of pain control for 17 trauma patients during the initial part of their stay in the intensive care unit, and assessed reasons for inadequate analgesia, if it occurred. Patients, and physicians, and nurses were interviewed. A verbal pain intensity scale was used to determine whether patients received adequate analgesia. Patients were asked if the pain hindered their activities, and whether they requested pain medication from their caregivers. Caregivers were questioned whether patients received adequate analgesia. Prescribed morphine regimens and the amount of narcotic administered were analyzed. Twenty-seven percent of patients rated pain intensity as moderate and 47% as severe. Ninety-five percent of housestaff and 81% of nurses reported the patients received adequate pain control. Forty-seven percent of the patients who had moderate or severe pain asked their physician for more pain medication, and 65% asked the nurse. Thirteen residents did not order a larger dose of morphine due to concern about respiratory depression or hypotension. Morphine dosages ranged from 1-8 mg intravenously every 1-2 hours as necessary. Nurses administered less than the maximum amount ordered 58% of the time. The mean dosing interval was 2.3 hours. Barriers to adequate pain management were disparity in the perception of pain between patients and caregivers; patients not requesting more analgesia despite despite the presence of moderate to severe pain; and physician and nurse concerns about patients' adverse physiologic response to increased dosages.
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee 53226, USA.
authors.forename: J K
authors.initials: JK
authors.lastname: Whipple
authors.forename: K S
authors.initials: KS
authors.lastname: Lewis
authors.forename: E J
authors.initials: EJ
authors.lastname: Quebbeman
authors.forename: M
authors.initials: M
authors.lastname: Wolff
authors.forename: M S
authors.initials: MS
authors.lastname: Gottlieb
authors.forename: M
authors.initials: M
authors.lastname: Medicus-Bringa
authors.forename: K R
authors.initials: KR
authors.lastname: Hartnett
authors.forename: M
authors.initials: M
authors.lastname: Graf
authors.forename: R K
authors.initials: RK
authors.lastname: Ausman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D016638:Critical Illness; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D010361:Patients / Q000523:psychology; D010820:Physicians / Q000523:psychology; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014193:Trauma Centers; D014922:Wisconsin; D014947:Wounds and Injuries / Q000503:physiopathology
chemical_list: D000700:Analgesics