TY - JOUR

T1 - Pain distress

T2 - the negative emotion associated with procedures in ICU patients

AU - Puntillo, Kathleen A

AU - Max, Adeline

AU - Timsit, Jean-Francois

AU - Ruckly, Stephane

AU - Chanques, Gerald

AU - Robleda, Gemma

AU - Roche-Campo, Ferran

AU - Mancebo, Jordi

AU - Divatia, Jigeeshu V

AU - Soares, Marcio

AU - Ionescu, Daniela C

AU - Grintescu, Ioana M

AU - Maggiore, Salvatore Maurizio

AU - Rusinova, Katerina

AU - Owczuk, Radoslaw

AU - Egerod, Ingrid

AU - Papathanassoglou, Elizabeth D E

AU - Kyranou, Maria

AU - Joynt, Gavin M

AU - Burghi, Gaston

AU - Freebairn, Ross C

AU - Ho, Kwok M

AU - Kaarlola, Anne

AU - Gerritsen, Rik T

AU - Kesecioglu, Jozef

AU - Sulaj, Miroslav M S

AU - Norrenberg, Michelle

AU - Benoit, Dominique D

AU - Seha, Myriam S G

AU - Hennein, Akram

AU - Pereira, Fernando J

AU - Benbenishty, Julie S

AU - Abroug, Fekri

AU - Aquilina, Andrew

AU - Monte, Julia R C

AU - An, Youzhong

AU - Azoulay, Elie

PY - 2018

Y1 - 2018

N2 - PURPOSE: The intensity of procedural pain in intensive care unit (ICU) patients is well documented. However, little is known about procedural pain distress, the psychological response to pain.METHODS: Post hoc analysis of a multicenter, multinational study of procedural pain. Pain distress was measured before and during procedures (0-10 numeric rating scale). Factors that influenced procedural pain distress were identified by multivariable analyses using a hierarchical model with ICU and country as random effects.RESULTS: A total of 4812 procedures were recorded (3851 patients, 192 ICUs, 28 countries). Pain distress scores were highest for endotracheal suctioning (ETS) and tracheal suctioning, chest tube removal (CTR), and wound drain removal (median [IQRs] = 4 [1.6, 1.7]). Significant relative risks (RR) for a higher degree of pain distress included certain procedures: turning (RR = 1.18), ETS (RR = 1.45), tracheal suctioning (RR = 1.38), CTR (RR = 1.39), wound drain removal (RR = 1.56), and arterial line insertion (RR = 1.41); certain pain behaviors (RR = 1.19-1.28); pre-procedural pain intensity (RR = 1.15); and use of opioids (RR = 1.15-1.22). Patient-related variables that significantly increased the odds of patients having higher procedural pain distress than pain intensity were pre-procedural pain intensity (odds ratio [OR] = 1.05); pre-hospital anxiety (OR = 1.76); receiving pethidine/meperidine (OR = 4.11); or receiving haloperidol (OR = 1.77) prior to the procedure.CONCLUSIONS: Procedural pain has both sensory and emotional dimensions. We found that, although procedural pain intensity (the sensory dimension) and distress (the emotional dimension) may closely covary, there are certain factors than can preferentially influence each of the dimensions. Clinicians are encouraged to appreciate the multidimensionality of pain when they perform procedures and use this knowledge to minimize the patient's pain experience.

AB - PURPOSE: The intensity of procedural pain in intensive care unit (ICU) patients is well documented. However, little is known about procedural pain distress, the psychological response to pain.METHODS: Post hoc analysis of a multicenter, multinational study of procedural pain. Pain distress was measured before and during procedures (0-10 numeric rating scale). Factors that influenced procedural pain distress were identified by multivariable analyses using a hierarchical model with ICU and country as random effects.RESULTS: A total of 4812 procedures were recorded (3851 patients, 192 ICUs, 28 countries). Pain distress scores were highest for endotracheal suctioning (ETS) and tracheal suctioning, chest tube removal (CTR), and wound drain removal (median [IQRs] = 4 [1.6, 1.7]). Significant relative risks (RR) for a higher degree of pain distress included certain procedures: turning (RR = 1.18), ETS (RR = 1.45), tracheal suctioning (RR = 1.38), CTR (RR = 1.39), wound drain removal (RR = 1.56), and arterial line insertion (RR = 1.41); certain pain behaviors (RR = 1.19-1.28); pre-procedural pain intensity (RR = 1.15); and use of opioids (RR = 1.15-1.22). Patient-related variables that significantly increased the odds of patients having higher procedural pain distress than pain intensity were pre-procedural pain intensity (odds ratio [OR] = 1.05); pre-hospital anxiety (OR = 1.76); receiving pethidine/meperidine (OR = 4.11); or receiving haloperidol (OR = 1.77) prior to the procedure.CONCLUSIONS: Procedural pain has both sensory and emotional dimensions. We found that, although procedural pain intensity (the sensory dimension) and distress (the emotional dimension) may closely covary, there are certain factors than can preferentially influence each of the dimensions. Clinicians are encouraged to appreciate the multidimensionality of pain when they perform procedures and use this knowledge to minimize the patient's pain experience.

U2 - 10.1007/s00134-018-5344-0

DO - 10.1007/s00134-018-5344-0

M3 - Journal article

C2 - 30128592

VL - 44

SP - 1493

EP - 1501

JO - European Journal of Intensive Care Medicine

JF - European Journal of Intensive Care Medicine

SN - 0935-1701

IS - 9

ER -