Pain Assessment and Management in the Critically Ill Patient
Published: 08 May 2018
Published: 08 May 2018
Pain ‘is a complex subjective phenomenon associated with actual or potential tissue damage’ (Prevost 2009).
Pain should be predicted in all patients and every action should be questioned for its possibility to cause pain or discomfort to the patient. Anticipation of pain allows alternative strategies to be considered or pre-emptive analgesics given (Mallet et al. 2013).
Pain can be:
(Department of Health and Social Care 2010)
The pain in most critically ill patients is considered as acute because it usually has an identified cause. For example, it may be associated with a procedure during the patient’s stay on the ward or postoperatively (Prevost 2009).
Critically ill patients are particularly vulnerable to pain and discomfort due to the severity of their health conditions and diagnostic and treatment interventions, such as:
Critically ill patients should be assessed for pain on a regular basis and the frequency of assessment should be patient-specific and adjusted according to their risk.
However, health professionals often underestimate patients’ pain and this is one of the main reason for inadequate pain management (Hamill-Ruth & Marohn 1999; Watt-Watson et al. 2001).
(Macintyre & Schug 2007)
Untreated pain can pose serious consequences for the already compromised, critically ill patient and can affect most body systems (Prevost 2009). Untreated pain could have the following effects:
( Macintyre & Schug 2007)
Careful consideration needs to be given to the assessment method chosen for critically ill patients because they are often unable to participate in the pain assessment process.
Below are some methods of assessing pain in critically ill patients:
This is considered the most reliable method of pain assessment.
This method is offered to patients who are able to communicate, even if not verbally (Puntillo et al. 2009). A numerical rating scale (NRS) with a standard scale of, for example, 0-10 (where 0 = pain-free and 10 = worst pain you can imagine), can still be used if the patient is able to point to the scale or nod at simple commands (Mallet et al. 2013).
The behavioural pain scale was developed to allow a more quantifiable assessment of pain (Payen et al. 2001) in patients who cannot self-report pain and are unable to be assessed with the numeric rating scale.
As many critically ill patients are unable to cooperate with a numeric rating scale they may require an alternative assessment. The BPS involves looking for pain-related behaviours and physiological indicators in order to plan treatment, such as:
(Jocabi et al. 2002)
However, physiological signs alone are a poor assessment of pain in the critically ill. That is because these signs are often present regardless of pain.
Therefore, pain assessment should be sure to include observations of behaviours and physiological signs, with any change in the physiological indicators after administering analgesics to be monitored (Jocabi et al. 2002).
When pain is indicated in the patient, follow the WHO analgesic ladder (WHO 1990) and take into account the patient’s co-morbidities and your institution’s usual selection of analgesics.
An analgesic regimen tailored specifically to the patient will take into account:
(Mallet et al. 2013)
Effective pain management is an important element of the nurses’ role. The effects of inadequate pain management are significant and can lead to delayed healing and prolonged recovery. The nurse, therefore, must be competent in pain assessment methods/tools and be able to administer and evaluate pain management techniques.
Lydia Nabwami is registered nurse who has worked in various healthcare settings including cardiac ward, cardiac critical care unit (ITU), general ITU, A&E department, nursing homes and community nursing. She uses her experience as a RN to write well-researched content that helps to attract and motivate audiences. Lydia is also a freelance writer for hire with specialisation in health writing and has helped numerous companies with their content needs. Her work has appeared on sites such as Caring Village, Reachout, Lisa Nelson RD and more. When she isn’t writing, you can find her listening to motivational speeches, keeping active or playing with her two daughters. Contact Lydia or visit her website at Lnwritingservices.co.uk for more information on her services.