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.
Puntillo
Kathleen
K
Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA. Electronic address: kathleen.puntillo@nursing.ucsf.edu.
Pasero
Chris
C
Pain Management Educator and Clinical Consultant, El Dorado Hills, CA.
Li
Denise
D
Department of Nursing & Health Sciences, College of Science, California State University, East Bay, Hayward, CA.
Mularski
Richard A
RA
Oregon Health & Science University, Portland, OR.
Grap
Mary Jo
MJ
Adult Health and Nursing Systems Department, School of Nursing, Virginia Commonwealth University, Richmond, VA.
Erstad
Brian L
BL
University of Arizona College of Pharmacy, Department of Pharmacy Practice & Science, Tucson, AZ.
Varkey
Basil
B
Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
Gilbert
Hugh C
HC
NorthShore University Health System, Northwestern University, Chicago, IL.
Medina
Justine
J
American Association of Critical Care Nurses, Aliso Viejo, CA.
Sessler
Curtis N
CN
Virginia Commonwealth University Health System, Richmond, VA.
D016638:Critical Illness; D006801:Humans; D007362:Intensive Care Units; D010147:Pain Measurement / Q000379:methods*; D019727:Proxy