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Postgraduate Education Corner: CONTEMPORARY REVIEWS IN CRITICAL CARE MEDICINE |

Evaluation of Pain in ICU Patients

Kathleen Puntillo, RN, CNS, DNSc; Chris Pasero, MS, RN-BC; Denise Li, PhD, RN, CNS; Richard A. Mularski, MD, MSHS, MCR, FCCP; Mary Jo Grap, PhD, RN; Brian L. Erstad, PharmD; Basil Varkey, MD, FCCP; Hugh C. Gilbert, MD; Justine Medina, RN, MS; Curtis N. Sessler, MD, FCCP
Author and Funding Information

*From the Department of Physiological Nursing (Dr. Puntillo), University of California, San Francisco, San Francisco, CA; Pain Management Educator and Clinical Consultant (Ms. Pasero), El Dorado Hills, CA; Department of Nursing & Health Sciences (Dr. Li), College of Science, California State University, East Bay, Hayward, CA; Oregon Health & Science University (Dr. Mularski), Portland, OR; Adult Health and Nursing Systems Department (Dr. Grap), School of Nursing, Virginia Commonwealth University, Richmond, VA; University of Arizona College of Pharmacy (Mr. Erstad), Department of Pharmacy Practice & Science, Tucson, AZ; Department of Medicine (Dr. Varkey), Medical College of Wisconsin, Milwaukee, WI; NorthShore University Health System (Dr. Gilbert), Northwestern University, Chicago, IL; Virginia Commonwealth University Health System (Dr. Sessler), Richmond, VA; and American Association of Critical Care Nurses (Ms. Medina), Aliso Viejo, CA.

Correspondence to: Kathleen Puntillo, RN, CNS, DNSc, Professor of Nursing and Co-Director, Critical Care/Trauma Program, Department of Physiological Nursing, 2 Koret Way, Box 0610, University of California, San Francisco, CA 94143-0610; e-mail: kathleen.puntillo@nursing.ucsf.edu


Dr. Puntillo has no relationships with industry, but she does make formal presentations at professional societies that are sometimes sponsored by industry. She has no personal contact with industry personnel or others that make those arrangements. Ms. Pasero discloses that her lectures, which cover general pain management, do not promote any products or equipment and are occasionally supported by industry (Baxter Healthcare Corporation, Ortho McNeil, and Johnson & Johnson). She is paid as a consultant to critique pain management products in development (eg, Alpharma, Johnson & Johnson); answer general pain management questions of industry customers, such as nurses, pharmacists, and physicians (Baxter Healthcare Corporation, Cardinal Health); and develop patient education materials (Endo Pharmaceutical). Drs. Li, Mularski, Grap, and Gilbert, and Mr. Erstad and Ms. Medina have no conflicts of interest to disclose. Dr. Varkey served as a speaker and in an advisory board meeting for Astra Zeneca in August 2008. Dr. Sessler received a grant from Physiometrix and served as a consultant and on the advisory committee for Hospira.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

For editorial comment see page 894

For related article see page 1075


Chest. 2009;135(4):1069-1074. doi:10.1378/chest.08-2369
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Pain is a common and distressing symptom in ICU patients. Yet a major challenge exists in assessing and evaluating the pain. Although the patient's self-report of pain is the “gold standard” for pain assessment, other methods must be considered when patients are unable to self-report. Currently only two pain behavior instruments have been tested for their reliability, validity, and feasibility of use in ICUs: the pain behavior scale and the Critical-Care Pain Observation Tool. Other tools, albeit with less validity testing, include the pain assessment, intervention, and notation (PAIN) algorithm and a pain behaviors checklist. When established tools are insufficient to evaluate a patient's pain, alternative methods of augmenting a pain evaluation should be considered. These can include the completion of a pain risk profile, use of surrogates, or performance of an analgesic trial. Meticulous attention to the evaluation of a critically ill patient's pain provides the basis for selection of pain interventions and the subsequent assessment of the intervention's effectiveness.


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