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
N1 - Funding Information:
Contributors: We recognize and thank patients and clinicians from the following ICUs who were involved in the Europain ? study.
Publisher Copyright:
© 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM.
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2018/9/1
Y1 - 2018/9/1
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.
KW - ICU
KW - Pain distress
KW - Procedures
UR - http://www.scopus.com/inward/record.url?scp=85052596534&partnerID=8YFLogxK
U2 - 10.1007/s00134-018-5344-0
DO - 10.1007/s00134-018-5344-0
M3 - Article
C2 - 30128592
AN - SCOPUS:85052596534
SN - 0342-4642
VL - 44
SP - 1493
EP - 1501
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 9
ER -