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Pain Assessment and Management in the Critically Ill: Wizardry or Science?

Assessment and management of patient pain across practice settings have received the increased attention of providers, patients, families, and regulatory agencies. Scientific advances in pain mechanisms, multidimensional pain assessment methods, and analgesic pharmacology have aided in the improvement of pain management practices. However, providing adequate pain control to critical care patients offers unique challenges to both practitioners and researchers.

Puntillo focused on assessing and treating procedural pain, tracing discoveries about pain in critically ill patients, and providing recommendations for improving the comfort of these patients.

A behavioral pain scale has been developed and validated as a method of scoring pain in critically ill sedated patients. The scale has a scoring range of 1 to 12 and three categories: facial expression, movements of upper limbs, and compliance with ventilator.

Presented were the significance and severity of pain to the patient undergoing common procedures, including endotracheal suctioning and chest tube removal, as well as those studied in Thunder Project II—turning, wound drain removal, tracheal suctioning, femoral sheath removal, and central venous catheter insertion. Selected findings were that turning was the most painful and distressing procedure for adults; wound care was the most painful and distressing procedure for adolescents; and tracheal suctioning and turning were painful procedures for children.

Findings from 2 studies related to premedication interventions for chest tube removal were also presented.

Kathleen Puntillo’s study will be published in its entirety in the July 2003 issue of the Journal.

This Article Full Text (PDF) Respond to This Article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Puntillo, K. Search for Related Content PubMed Articles by Puntillo, K.