Pain Management in the Critically Ill Patient

• Pain is common, often underappreciated, and routinely undertreated in our critically ill patients.
• Poorly treated pain has been shown to adversely affect both short- and long-term outcomes.
• Key pearls when treating pain in the critically ill:
  • Vital signs should not be used in isolation to assess pain
  • Use a validated assessment tool to objectively quantify pain (i.e., Critical Care Pain Observation Tool)
  • An analgosedation strategy (analgesics before sedative medications) has been shown to decrease duration of mechanical ventilation and decrease ICU LOS
  • Opioids have no maximum or ceiling dose. The appropriate dose is that which controls pain with the fewest side effects.

References

Sigakis MJG, Bittner EA. Ten myths and misconceptions regarding pain management in the ICU. Crit Care Med 2015; 43:2468-2478.