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Title: Pain distress: the negative emotion associated with procedures in ICU patients
Authors: Puntillo, Kathleen A. 
Max, Adeline 
Timsit, Jean-Francois 
Ruckly, Stephane 
Chanques, Gerald 
Robleda, Gemma 
Roche-Campo, Ferran 
Mancebo, Jordi 
Divatia, Jigeeshu V. 
Soares, Marcio 
Ionescu, Daniela C. 
Grintescu, Ioana M. 
Maggiore, Salvatore Maurizio 
Rusinova, Katerina 
Owczuk, Radoslaw 
Egerod, Ingrid 
Papathanassoglou, Elizabeth 
Kyranou, Maria 
Joynt, Gavin M. 
Burghi, Gaston 
Freebairn, Ross C. 
Ho, Kwok M. 
Kaarlola, Anne 
Gerritsen, Rik T. 
Kesecioglu, Jozef 
Sulaj, Miroslav M. S. 
Norrenberg, Michelle 
Benoit, Dominique D. 
Seha, Myriam S. G. 
Hennein, Akram 
Pereira, Fernando J 
Benbenishty, Julie Sarah 
Abroug, Fekri 
Aquilina, Andrew 
Monte, Julia R. C. 
An, Youzhong 
Azoulay, Elie 
Major Field of Science: Medical and Health Sciences
Field Category: Health Sciences
Keywords: ICU;Pain distress;Procedures
Issue Date: 1-Sep-2018
Source: Intensive Care Medicine, 2018, vol. 44, no. 9, pp. 1493-1501
Volume: 44
Issue: 9
Start page: 1493
End page: 1501
Journal: Intensive care medicine 
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.
ISSN: 0342-4642
DOI: 10.1007/s00134-018-5344-0
Rights: © Springer-Verlag GmbH Germany, part of Springer Nature and ESICM.
Type: Article
Affiliation : University of California 
University of Paris-Diderot 
AP-HP - Réanimation Medicale et des maladies infectieuses - Hôpital Bichat 
Montpellier University 
Hospital de Sant Pau 
Hospital Verge de la Cinta 
Homi Bhabha National Institute 
D’Or Institute for Research and Education 
Iuliu Hatieganu University of Medicine and Pharmacy 
Outcomes Research Consortium 
Clinical Emergency Hospital 
Università G. d’Annunzio Chieti-Pescara 
Charles University 
Medical University of Gdansk 
University of Copenhagen 
Cyprus University of Technology 
University of Alberta 
The Chinese University of Hong Kong 
Hospital Maciel 
Hawke’s Bay Hospital 
University of Western Australia 
Helsinki University Hospital 
Medical Centre Leeuwarden 
University Medical Center Utrecht 
Comenius University in Bratislava 
Danube Hospital 
Universite Libre de Bruxelles 
Ghent University 
Spital Maennedorf 
Mansoura Emergency University Hospital 
Clinica Las Americas 
Hadassah Hebrew University Medical Center 
Mater Dei Hospital 
Centro Hospitalar do Porto 
Peking University People’s Hospital 
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