title: Determinants of procedural pain intensity in the intensive care unit. The Europain® study.
abstract: BACKGROUND
  Intensive care unit (ICU) patients undergo several diagnostic and therapeutic procedures every day. The prevalence, intensity, and risk factors of pain related to these procedures are not well known.
  
  
  OBJECTIVE
  To assess self-reported procedural pain intensity versus baseline pain, examine pain intensity differences across procedures, and identify risk factors for procedural pain intensity.
  
  
  METHODS
  Prospective, cross-sectional, multicenter, multinational study of pain intensity associated with 12 procedures. Data were obtained from 3,851 patients who underwent 4,812 procedures in 192 ICUs in 28 countries.
  
  
  RESULTS
  Pain intensity on a 0-10 numeric rating scale increased significantly from baseline pain during all procedures (P < 0.001). Chest tube removal, wound drain removal, and arterial line insertion were the three most painful procedures, with median pain scores of 5 (3-7), 4.5 (2-7), and 4 (2-6), respectively. By multivariate analysis, risk factors independently associated with greater procedural pain intensity were the specific procedure; opioid administration specifically for the procedure; preprocedural pain intensity; preprocedural pain distress; intensity of the worst pain on the same day, before the procedure; and procedure not performed by a nurse. A significant ICU effect was observed, with no visible effect of country because of its absorption by the ICU effect. Some of the risk factors became nonsignificant when each procedure was examined separately.
  
  
  CONCLUSIONS
  Knowledge of risk factors for greater procedural pain intensity identified in this study may help clinicians select interventions that are needed to minimize procedural pain. Clinical trial registered with www.clinicaltrials.gov (NCT 01070082).
authors.affiliation: 1 Department of Physiological Nursing, University of California, San Francisco, San Francisco, California.
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mesh_terms: D000368:Aged; D002406:Catheterization, Peripheral / Q000009:adverse effects; D015505:Chest Tubes / Q000009:adverse effects; D003430:Cross-Sectional Studies; D020878:Device Removal / Q000009:adverse effects; D019937:Diagnostic Techniques and Procedures / Q000009:adverse effects*; D004322:Drainage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology*; D010147:Pain Measurement; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013812:Therapeutics / Q000009:adverse effects*; D014947:Wounds and Injuries / Q000628:therapy