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Postgraduate Education Corner: CONTEMPORARY REVIEWS IN CRITICAL CARE MEDICINE |

Structured Approaches to Pain Management in the ICU

Chris Pasero, MS, RN-BC; Kathleen Puntillo, RN, CNS, DNSc; 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

*Independent Pain Management Educator and Clinical Consultant (Ms. Pasero), El Dorado Hills, CA; Critical Care/Trauma Program Department of Physiological Nursing (Dr. Puntillo), University of California, San Francisco, CA; Department of Nursing and Health Sciences (Dr. Li), College of Science, California State University, East Bay, Hayward, CA; The Center for Health Research (Dr. Mularski), Kaiser Permanente Northwest and Oregon Health and Science University, Portland, OR; Adult Health and Nursing Systems Department (Dr. Grap), School of Nursing, Virginia Commonwealth University, Richmond, VA; The University of Arizona College of Pharmacy (Dr. Erstad), Department of Pharmacy Practice and Science, Tucson, AZ; Division of Pulmonary and Critical Care (Dr. Varkey), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Northwestern University Department of Anesthesiology (Dr. Gilbert), Feinberg School of Medicine, Chicago, IL; Professional Practice and Programs (Ms. Medina), American Association of Critical Care Nurses, Aliso Viejo, CA; and Virginia Commonwealth University Health System (Dr. Sessler), Richmond, VA.

Correspondence to: Chris Pasero, MS, RN-BC, Pain Management Educator and Clinical Consultant, 1252 Clearview Dr, El Dorado Hills, CA 95762; e-mail: cpasero@aol.com


No conflict of interest exists for any of the authors.

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


© 2009 American College of Chest Physicians


Chest. 2009;135(6):1665-1672. doi:10.1378/chest.08-2333
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Pain in patients who are critically ill remains undertreated despite decades of research, guideline development and distribution, and intense educational efforts. By nature of their complex medical conditions, these patients present unique challenges to the delivery of optimal pain treatment. Outdated clinical practices and faulty systems, such as a formulary that allows dangerous prescriptions, present additional obstacles. A multidisciplinary and patient-centered continuous quality improvement process is essential to identifying barriers and implementing evidence-based solutions to the problem of undertreated pain in hospital ICUs. This article addresses barriers common to the ICU setting and presents a number of structured approaches that have been shown to be successful in improving pain treatment in patients who are critically ill.


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