title: Structured approaches to pain management in the ICU.
abstract: Pain in patients who are critically ill remains undertreated despite decades of research, guideline development and distribution, and intense educational efforts. By nature of their complex medical conditions, these patients present unique challenges to the delivery of optimal pain treatment. Outdated clinical practices and faulty systems, such as a formulary that allows dangerous prescriptions, present additional obstacles. A multidisciplinary and patient-centered continuous quality improvement process is essential to identifying barriers and implementing evidence-based solutions to the problem of undertreated pain in hospital ICUs. This article addresses barriers common to the ICU setting and presents a number of structured approaches that have been shown to be successful in improving pain treatment in patients who are critically ill.
authors.affiliation: Independent Pain Management Educator and Clinical Consultant, El Dorado Hills, CA. Electronic address: cpasero@aol.com.
authors.forename: Chris
authors.initials: C
authors.lastname: Pasero
authors.affiliation: Critical Care/Trauma Program Department of Physiological Nursing, University of California, San Francisco, CA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Puntillo
authors.affiliation: Department of Nursing and Health Sciences, College of Science, California State University, East Bay, Hayward, CA.
authors.forename: Denise
authors.initials: D
authors.lastname: Li
authors.affiliation: The Center for Health Research, Kaiser Permanente Northwest and Oregon Health and Science University, Portland, OR.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Mularski
authors.affiliation: Adult Health and Nursing Systems Department, School of Nursing, Virginia Commonwealth University, Richmond, VA.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Grap
authors.affiliation: The University of Arizona College of Pharmacy, Department of Pharmacy Practice and Science, Tucson, AZ.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Erstad
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Basil
authors.initials: B
authors.lastname: Varkey
authors.affiliation: Northwestern University Department of Anesthesiology, Feinberg School of Medicine, Chicago, IL.
authors.forename: Hugh C
authors.initials: HC
authors.lastname: Gilbert
authors.affiliation: Professional Practice and Programs, American Association of Critical Care Nurses, Aliso Viejo, CA.
authors.forename: Justine
authors.initials: J
authors.lastname: Medina
authors.affiliation: Virginia Commonwealth University Health System, Richmond, VA.
authors.forename: Curtis N
authors.initials: CN
authors.lastname: Sessler
mesh_terms: D000698:Analgesia / Q000592:standards* / Q000639:trends; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D003131:Combined Modality Therapy; D003422:Critical Care / Q000592:standards; D016638:Critical Illness / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D010148:Intractable Pain / Q000175:diagnosis / Q000628:therapy*; D010348:Patient Care Team / Q000592:standards*; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D018570:Risk Assessment; D014481:United States
chemical_list: D000701:Analgesics, Opioid