Pain in intensive care unit patients-A longitudinal study.
Brita F Olsen, Berit T Valeberg, Morten Jacobsen and 3 others
PMID 33318830WHAT IT FOUND
With regular pain assessments, most ICU patients were not in pain over the first 6 days, but turning was more painful than rest.
Patients able to self-report were more often in pain than those assessed by behaviour scales.
Key findings
01Over the first 6 days, 27.4% of turning assessments and 10.1% of rest assessments were pain events.
02Pain was more common in patients able to self-report than in patients not able to self-report: 20.8% versus 3.1% at rest, and 39.1% versus 21.5% during turning.
03Day 4 had the most pain during turning (31.1%) and the fewest patients receiving analgesics (72.8%).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a secondary analysis of data collected during a pain algorithm intervention, not a randomised trial, so it cannot show that the algorithm caused the pain levels. Only the first 6 ICU days were analysed, while ICU stays ranged from 1 to 62 days and median stay was 3.2 days, so later pain patterns were not captured. Medication records showed daily opioid and sedative use, but not doses or timing, so pain could not be linked to how much or when treatment was given. Pain was assessed by different tools depending on ability to self-report, and behavioural scales may not capture pain as accurately as self-report. Data came from two Norwegian hospitals and included only patients managed with the algorithm.
Declared interests
The authors declared no ethical or financial conflicts. The work was supported by Helse Sør-Øst RHF.
The easy way to misread this
Do not conclude that ICU pain is adequately controlled because most assessments were not pain events. Turning was more painful than rest, day 4 had the most turning pain, and patients unable to self-report had lower recorded pain, which may reflect measurement differences rather than comfort.