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01-09-2018 | Original

Pain distress: the negative emotion associated with procedures in ICU patients

Authors: Kathleen A. Puntillo, Adeline Max, Jean-Francois Timsit, Stephane Ruckly, Gerald Chanques, Gemma Robleda, Ferran Roche-Campo, Jordi Mancebo, Jigeeshu V. Divatia, Marcio Soares, Daniela C. Ionescu, Ioana M. Grintescu, Salvatore Maurizio Maggiore, Katerina Rusinova, Radoslaw Owczuk, Ingrid Egerod, Elizabeth D. E. Papathanassoglou, Maria Kyranou, Gavin M. Joynt, Gaston Burghi, Ross C. Freebairn, Kwok M. Ho, Anne Kaarlola, Rik T. Gerritsen, Jozef Kesecioglu, Miroslav M. S. Sulaj, Michelle Norrenberg, Dominique D. Benoit, Myriam S. G. Seha, Akram Hennein, Fernando J. Pereira, Julie S. Benbenishty, Fekri Abroug, Andrew Aquilina, Julia R. C. Monte, Youzhong An, Elie Azoulay

Published in: Intensive Care Medicine | Issue 9/2018

Abstract

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.

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Title: Pain distress: the negative emotion associated with procedures in ICU patients
Authors: Kathleen A. Puntillo
Adeline Max
Jean-Francois Timsit
Stephane Ruckly
Gerald Chanques
Gemma Robleda
Ferran Roche-Campo
Jordi Mancebo
Jigeeshu V. Divatia
Marcio Soares
Daniela C. Ionescu
Ioana M. Grintescu
Salvatore Maurizio Maggiore
Katerina Rusinova
Radoslaw Owczuk
Ingrid Egerod
Elizabeth D. E. Papathanassoglou
Maria Kyranou
Gavin M. Joynt
Gaston Burghi
Ross C. Freebairn
Kwok M. Ho
Anne Kaarlola
Rik T. Gerritsen
Jozef Kesecioglu
Miroslav M. S. Sulaj
Michelle Norrenberg
Dominique D. Benoit
Myriam S. G. Seha
Akram Hennein
Fernando J. Pereira
Julie S. Benbenishty
Fekri Abroug
Andrew Aquilina
Julia R. C. Monte
Youzhong An
Elie Azoulay
Publication date: 01-09-2018
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 9/2018
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-018-5344-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Pain distress: the negative emotion associated with procedures in ICU patients

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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