Pathophysiology, assessment, and management of pain in critically ill adults

American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists
David P ReardonPaul M Szumita

Abstract

The pathophysiology of pain in critically ill patients, the role of pain assessment in optimal pain management, and pharmacologic and nonpharmacologic strategies for pain prevention and treatment are reviewed. There are many short- and long-term consequences of inadequately treated pain, including hyperglycemia, insulin resistance, an increased risk of infection, decreased patient comfort and satisfaction, and the development of chronic pain. Clinicians should have an understanding of the basic physiology of pain and the patient populations that are affected. Pain should be assessed using validated pain scales that are appropriate for the patient's communication status. Opioids are the cornerstone of pain treatment. The use of opioids, administered via bolus dosing or continuous infusion, should be guided by patient-specific goals of care in order to avoid adverse events. A multimodal approach to pain management, including the use of regional analgesia, may improve patient outcomes and decrease opioid-related adverse events, though there are limited relevant data in adult critically ill patient populations. Nonpharmacologic strategies have been shown to be effective adjuncts to pharmacologic regimens that can improve patient-re...Continue Reading

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Citations

Jan 27, 2016·Pharmacological Research : the Official Journal of the Italian Pharmacological Society·Rafael C DutraJoão B Calixto
Jan 10, 2019·BMJ Open Quality·Sophie StangerAndrew Tasker
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Oct 11, 2020·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Stephy George, Meagan Johns
Jun 26, 2021·Clinical Therapeutics·Jesús CebrecosCarlos Plata-Salamán
Aug 17, 2021·Dimensions of Critical Care Nursing : DCCN·Cheryl B Hines, Clara R Owings

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