title: Procedural pain does not raise plasma levels of cortisol or catecholamines in adult intensive care patients after cardiac surgery.
abstract: The gold standard for quantification of pain is a person's self-report. However, we need objective parameters for pain measurement when intensive care patients, for example, are not able to report pain themselves. An increase in pain is currently thought to coincide with an increase in stress hormones. This observational study investigated whether procedure-related pain is associated with an increase of plasma cortisol, adrenaline, and noradrenaline. In 59 patients receiving intensive care after cardiac surgery, cortisol, adrenaline, and noradrenaline plasma levels were measured immediately before and immediately after patients were turned for washing, either combined with the removal of chest tubes or not. Numeric rating scale scores were obtained before, during, and after the procedure. Unacceptably severe pain (numeric rating scale ≥ 4) was reported by seven (12%), 26 (44%), and nine (15%) patients, before, during and after the procedure, respectively. There was no statistically significant association between numeric rating scale scores and change in cortisol, adrenaline, and noradrenaline plasma levels during the procedure. Despite current convictions that pain coincides with an increase in stress hormones, procedural pain was not associated with a significant increase in plasma stress hormone levels in patients who had undergone cardiac surgery. Thus, plasma levels of cortisol, adrenaline, and noradrenaline seem unsuitable for further research on the measurement of procedural pain.
authors.affiliation: Department of Intensive Care, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: van Gulik
authors.affiliation: Department of Clinical Pharmacy, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Sjgm
authors.initials: S
authors.lastname: Ahlers
authors.affiliation: Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van Dijk
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Management, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Bruins
authors.affiliation: Division of Vascular Medicine and Pharmacology, Erasmus, Rotterdam, The Netherlands.
authors.forename: M E
authors.initials: ME
authors.lastname: Meima
authors.affiliation: Department of Clinical Chemistry, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Y B
authors.initials: YB
authors.lastname: de Rijke
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Management and Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: H S
authors.initials: HS
authors.lastname: Biemond-Moeniralam
authors.affiliation: Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Tibboel
authors.affiliation: Department of Clinical Pharmacy, St Antonius Hospital, and Department of Intensive Care, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: C A J
authors.initials: CA
authors.lastname: Knibbe
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D002395:Catecholamines / Q000097:blood*; D003422:Critical Care; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D010149:Postoperative Pain / Q000097:blood*
chemical_list: D002395:Catecholamines; D006854:Hydrocortisone
keywords: adrenaline; cardiac surgical procedures; chest tubes; hydrocortisone; noradrenaline; pain measurement