Assessing Pain in Critically Ill Adults

Scope and Impact of the Problem

Many critically ill adult patients experience significant pain as indicated by a score on a numeric rating scale greater than 4.¹ Furthermore, more than 50% have significant pain during procedures or routine care (eg, chest tube removal, endotracheal suctioning, wound care, turning/repositioning).^2,3Even a dressing change can cause pain.⁴

Untreated pain can result in negative consequences, including adverse events (eg, tachycardia/bradycardia, hypertension/hypotension, desaturation, bradypnea)⁵ and the development of chronic pain.^6,7 Conversely, treating pain first, before sedative use (analgosedation) can significantly decrease pain scores, duration of mechanical ventilation, and length of stay in the intensive care unit (ICU).⁸

Because pain is multidimensional and subjective,⁹ the patient's self-report is the gold standard for assessment. However, many adult patients in the ICU cannot self-report pain as a result of an altered level of consciousness, mechanical ventilation, and/or the administration of sedative agents. The lack of self-reporting makes assessing pain in critically ill patients a challenge for nurses, who should consider use of alternatives such as behavioral pain assessment tools.^1,10