Evaluation of pain in ICU patients.
Pain is a common and distressing symptom in ICU patients. Yet a major challenge exists in assessing and evaluating the pain. Although the patient's self-report of pain is the "gold standard" for pain assessment, other methods must be considered when patients are unable to self-report. Currently only two pain behavior instruments have been tested for their reliability, validity, and feasibility of use in ICUs: the pain behavior scale and the Critical-Care Pain Observation Tool. Other tools, albeit with less validity testing, include the pain assessment, intervention, and notation (PAIN) algorithm and a pain behaviors checklist. When established tools are insufficient to evaluate a patient's pain, alternative methods of augmenting a pain evaluation should be considered. These can include the completion of a pain risk profile, use of surrogates, or performance of an analgesic trial. Meticulous attention to the evaluation of a critically ill patient's pain provides the basis for selection of pain interventions and the subsequent assessment of the intervention's effectiveness.
Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA. Electronic address: kathleen.puntillo@nursing.ucsf.edu.
Kathleen
K
Puntillo
Pain Management Educator and Clinical Consultant, El Dorado Hills, CA.
Chris
C
Pasero
Department of Nursing & Health Sciences, College of Science, California State University, East Bay, Hayward, CA.
Denise
D
Li
Oregon Health & Science University, Portland, OR.
Richard A
RA
Mularski
Adult Health and Nursing Systems Department, School of Nursing, Virginia Commonwealth University, Richmond, VA.
Mary Jo
MJ
Grap
University of Arizona College of Pharmacy, Department of Pharmacy Practice & Science, Tucson, AZ.
Brian L
BL
Erstad
Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
Basil
B
Varkey
NorthShore University Health System, Northwestern University, Chicago, IL.
Hugh C
HC
Gilbert
American Association of Critical Care Nurses, Aliso Viejo, CA.
Justine
J
Medina
Virginia Commonwealth University Health System, Richmond, VA.
Curtis N
CN
Sessler
D016638:Critical Illness; D006801:Humans; D007362:Intensive Care Units; D010147:Pain Measurement / Q000379:methods*; D019727:Proxy