Kathleen A Puntillo1, Adeline Max2, Jean-Francois Timsit3, Stephane Ruckly4, Gerald Chanques5,6, Gemma Robleda7, Ferran Roche-Campo8, Jordi Mancebo7, Jigeeshu V Divatia9, Marcio Soares10, Daniela C Ionescu11,12, Ioana M Grintescu13, Salvatore Maurizio Maggiore14, Katerina Rusinova15, Radoslaw Owczuk16, Ingrid Egerod17, Elizabeth D E Papathanassoglou18,19, Maria Kyranou18, Gavin M Joynt20, Gaston Burghi21, Ross C Freebairn22, Kwok M Ho23, Anne Kaarlola24, Rik T Gerritsen25, Jozef Kesecioglu26, Miroslav M S Sulaj27,28, Michelle Norrenberg29, Dominique D Benoit30, Myriam S G Seha31, Akram Hennein32, Fernando J Pereira33, Julie S Benbenishty34, Fekri Abroug35, Andrew Aquilina36, Julia R C Monte37, Youzhong An38, Elie Azoulay2. 1. Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA, 94143-0610, USA. kathleen.puntillo@ucsf.edu. 2. Medical Intensive Care Unit, University of Paris-Diderot, Saint Louis Hospital, Paris, France. 3. AP-HP - Réanimation Medicale et des maladies infectieuses - Hôpital Bichat, 75018, Paris, France. 4. INSERM, IAME, UMR 1137, Team DesCID, 75018, Paris, France. 5. Department of Anesthesia and Intensive Care, Montpellier University, Hopital Saint Eloi, Montpellier, France. 6. PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France. 7. Servei de Medicina Intensiva, Hospital de Sant Pau, Barcelona, Spain. 8. Servei de Medicina intensiva, Hospital Verge de la Cinta, Tortosa, Spain. 9. Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India. 10. Critical Care Departmemt and Graduate Program in Medical Sciences, Postgraduate Program, D'Or Institute for Research and Education, Rio de Janeiro, Brazil. 11. Department of Anesthesia and Intensive Care I, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. 12. Outcome Research Consortium, Cleveland, USA. 13. Anesthesia and Intensive Care Department, Clinical Emergency Hospital, Bucharest, Romania. 14. Department of Anesthesiology and Intensive Care, Policlinico SS. Annunziata, Università G. d'Annunzio Chieti-Pescara, Chieti, Italy. 15. Department of Anaesthesiology and Intensive Care, General University Hospital, First Faculty of Medicine of Charles University, Prague, Czech Republic. 16. Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Gdansk, Poland. 17. Intensive Care Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 18. Department of Nursing, Cyprus University of Technology, Limassol, Cyprus. 19. Faculty of Nursing, University of Alberta, Edmonton, Canada. 20. Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong. 21. Intensive Care Unit, Hospital Maciel, Sanatorio Americano, Montevideo, Uruguay. 22. Intensive Care Services, Hawke's Bay Hospital, Hastings, New Zealand. 23. Department of Intensive Care Medicine and School of Population Health, Royal Perth Hospital and University of Western Australia, Perth, Australia. 24. Department of Surgery, Helsinki University Hospital, Helsinki, Finland. 25. Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands. 26. Department of Intensive Care Medicine, University Medical Center, Utrecht, Netherlands. 27. Dept. of Hematology and Transfusiology, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Martin, Slovakia. 28. Department of Anesthesiology and Intensive Medicine, Danube Hospital, Vienna, Austria. 29. Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. 30. Department of Intensive Care, Ghent University, Ghent, Belgium. 31. ICU Maennedorf, Spital Maennedorf, Maennedorf, Switzerland. 32. Consultant Critical Care, Mansoura Emergency University Hospital, Mansoura, Egypt. 33. Servicio Medicina Crítica y Cuidados Intensivos, Clínica Las Américas, Medellín, Colombia. 34. ICU, Hadassah Hebrew University Hospital, Jerusalem, Israel. 35. Intensive Care Unit, CHU F. Bourguiba, Monastir, Tunisia. 36. Department of Anaesthesia and Intensive Care, Mater Dei Hospital, Msida, Malta. 37. Servico Cuidados Intensivos, Hospital Santo Antonio, Centro Hospitalar do Porto, Porto, Portugal. 38. Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China.
Abstract
PURPOSE: The intensity of procedural pain in intensive care unit (ICU) patients is well documented. However, little is known about procedural pain distress, the psychological response to pain. METHODS: Post hoc analysis of a multicenter, multinational study of procedural pain. Pain distress was measured before and during procedures (0-10 numeric rating scale). Factors that influenced procedural pain distress were identified by multivariable analyses using a hierarchical model with ICU and country as random effects. RESULTS: A total of 4812 procedures were recorded (3851 patients, 192 ICUs, 28 countries). Pain distress scores were highest for endotracheal suctioning (ETS) and tracheal suctioning, chest tube removal (CTR), and wound drain removal (median [IQRs] = 4 [1.6, 1.7]). Significant relative risks (RR) for a higher degree of pain distress included certain procedures: turning (RR = 1.18), ETS (RR = 1.45), tracheal suctioning (RR = 1.38), CTR (RR = 1.39), wound drain removal (RR = 1.56), and arterial line insertion (RR = 1.41); certain pain behaviors (RR = 1.19-1.28); pre-procedural pain intensity (RR = 1.15); and use of opioids (RR = 1.15-1.22). Patient-related variables that significantly increased the odds of patients having higher procedural pain distress than pain intensity were pre-procedural pain intensity (odds ratio [OR] = 1.05); pre-hospital anxiety (OR = 1.76); receiving pethidine/meperidine (OR = 4.11); or receiving haloperidol (OR = 1.77) prior to the procedure. CONCLUSIONS: Procedural pain has both sensory and emotional dimensions. We found that, although procedural pain intensity (the sensory dimension) and distress (the emotional dimension) may closely covary, there are certain factors than can preferentially influence each of the dimensions. Clinicians are encouraged to appreciate the multidimensionality of pain when they perform procedures and use this knowledge to minimize the patient's pain experience.
PURPOSE: The intensity of procedural pain in intensive care unit (ICU) patients is well documented. However, little is known about procedural pain distress, the psychological response to pain. METHODS: Post hoc analysis of a multicenter, multinational study of procedural pain. Pain distress was measured before and during procedures (0-10 numeric rating scale). Factors that influenced procedural pain distress were identified by multivariable analyses using a hierarchical model with ICU and country as random effects. RESULTS: A total of 4812 procedures were recorded (3851 patients, 192 ICUs, 28 countries). Pain distress scores were highest for endotracheal suctioning (ETS) and tracheal suctioning, chest tube removal (CTR), and wound drain removal (median [IQRs] = 4 [1.6, 1.7]). Significant relative risks (RR) for a higher degree of pain distress included certain procedures: turning (RR = 1.18), ETS (RR = 1.45), tracheal suctioning (RR = 1.38), CTR (RR = 1.39), wound drain removal (RR = 1.56), and arterial line insertion (RR = 1.41); certain pain behaviors (RR = 1.19-1.28); pre-procedural pain intensity (RR = 1.15); and use of opioids (RR = 1.15-1.22). Patient-related variables that significantly increased the odds of patients having higher procedural pain distress than pain intensity were pre-procedural pain intensity (odds ratio [OR] = 1.05); pre-hospital anxiety (OR = 1.76); receiving pethidine/meperidine (OR = 4.11); or receiving haloperidol (OR = 1.77) prior to the procedure. CONCLUSIONS: Procedural pain has both sensory and emotional dimensions. We found that, although procedural pain intensity (the sensory dimension) and distress (the emotional dimension) may closely covary, there are certain factors than can preferentially influence each of the dimensions. Clinicians are encouraged to appreciate the multidimensionality of pain when they perform procedures and use this knowledge to minimize the patient's pain experience.
Authors: K A Puntillo; C White; A B Morris; S T Perdue; J Stanik-Hutt; C L Thompson; L R Wild Journal: Am J Crit Care Date: 2001-07 Impact factor: 2.228
Authors: Carol Tishelman; Lesley F Degner; Ann Rudman; Kristina Bertilsson; Ruth Bond; Eva Broberger; Eva Doukkali; Helena Levealahti Journal: Cancer Date: 2005-11-01 Impact factor: 6.860
Authors: E W Ely; S K Inouye; G R Bernard; S Gordon; J Francis; L May; B Truman; T Speroff; S Gautam; R Margolin; R P Hart; R Dittus Journal: JAMA Date: 2001-12-05 Impact factor: 56.272
Authors: Kathleen A Puntillo; Shoshana Arai; Neal H Cohen; Michael A Gropper; John Neuhaus; Steven M Paul; Christine Miaskowski Journal: Crit Care Med Date: 2010-11 Impact factor: 7.598
Authors: Kathleen A Puntillo; Adeline Max; Jean-Francois Timsit; Lucile Vignoud; Gerald Chanques; Gemma Robleda; Ferran Roche-Campo; Jordi Mancebo; Jigeeshu V Divatia; Marcio Soares; Daniela C Ionescu; Ioana M Grintescu; Irena L Vasiliu; Salvatore Maurizio Maggiore; Katerina Rusinova; Radoslaw Owczuk; Ingrid Egerod; Elizabeth D E Papathanassoglou; Maria Kyranou; Gavin M Joynt; Gastón Burghi; Ross C Freebairn; Kwok M Ho; Anne Kaarlola; Rik T Gerritsen; Jozef Kesecioglu; Miroslav M S Sulaj; Michelle Norrenberg; Dominique D Benoit; Myriam S G Seha; Akram Hennein; Fernando J Periera; Julie S Benbenishty; Fekri Abroug; Andrew Aquilina; Júlia R C Monte; Youzhong An; Elie Azoulay Journal: Am J Respir Crit Care Med Date: 2014-01-01 Impact factor: 21.405
Authors: Julien Amour; Bernard Cholley; Alexandre Ouattara; Dan Longrois; Pascal Leprince; Jean-Luc Fellahi; Bruno Riou; Sarah Hariri; Christian Latrémouille; Alain Rémy; Sophie Provenchère; Aude Carillion; Paul Achouh; Louis Labrousse; Alexy Tran Dinh; Nora Ait Hamou; Ahmed Charfeddine; Alexandre Lafourcade; David Hajage; Adrien Bouglé Journal: Intensive Care Med Date: 2019-01-07 Impact factor: 17.440
Authors: Bruno Adler Maccagnan Pinheiro Besen; Antonio Paulo Nassar Júnior; Fábio Holanda Lacerda; Carla Marchini Dias da Silva; Vanessa Tota de Souza; Eliana Vieira do Nascimento Martins; Ana Tarina Alvarez Lopes; Carlos Eduardo Brandão; Lucas Fernandes de Oliveira Journal: Rev Bras Ter Intensiva Date: 2019 Oct-Dec