Pain management principles in the critically ill

Brian L Erstad, Kathleen Puntillo, Hugh C. Gilbert, Mary Jo Grap, Denise Li, Justine Medina, Richard A. Mularski, Chris Pasero, Basil Varkey, Curtis N. Sessler

Research output: Contribution to journalArticle

79 Citations (Scopus)

Abstract

This article addresses conventional pharmacologic and nonpharmacologic treatment of pain in patients in ICUs. For the critically ill patient, opioids have been the mainstay of pain control. The optimal choice of opioid and dosing regimen for a specific patient varies depending on factors such as the pharmacokinetics and physicochemical characteristics of an opioid and the body's handling of the opioid, concomitant sedative regimen, potential or actual adverse drug events, and development of tolerance. The clinician must appreciate that favorable pharmacokinetic properties such as a short-elimination half-life do not necessarily translate into clinical advantages in the ICU setting. A variety of medications have been proposed as alternatives or adjuncts to the opioids for pain control that have unique considerations when contemplated for use in the critically ill patient. Most have been relatively unstudied in the ICU setting, and many have limitations with respect to availability of the GI route of administration in patients with questionable GI absorptive function. Nonpharmacologic, complementary therapies are low cost, easy to provide, and safe, and many clinicians can implement them with little difficulty or resources. However, the evidence base for their effectiveness is limited. At present, insufficient research evidence is available to support a broad implementation of nonpharmacologic therapies in ICUs.

Original languageEnglish (US)
Pages (from-to)1075-1086
Number of pages12
JournalChest
Volume135
Issue number4
DOIs
StatePublished - Apr 1 2009

Fingerprint

Pain Management
Critical Illness
Opioid Analgesics
Pain
Pharmacokinetics
Complementary Therapies
Drug-Related Side Effects and Adverse Reactions
Hypnotics and Sedatives
Half-Life
Costs and Cost Analysis
Therapeutics
Research

Keywords

  • Analgesics
  • Critical care
  • Nonpharmacologic interventions
  • Opioid
  • Pain

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Erstad, B. L., Puntillo, K., Gilbert, H. C., Grap, M. J., Li, D., Medina, J., ... Sessler, C. N. (2009). Pain management principles in the critically ill. Chest, 135(4), 1075-1086. https://doi.org/10.1378/chest.08-2264

Pain management principles in the critically ill. / Erstad, Brian L; Puntillo, Kathleen; Gilbert, Hugh C.; Grap, Mary Jo; Li, Denise; Medina, Justine; Mularski, Richard A.; Pasero, Chris; Varkey, Basil; Sessler, Curtis N.

In: Chest, Vol. 135, No. 4, 01.04.2009, p. 1075-1086.

Research output: Contribution to journalArticle

Erstad, BL, Puntillo, K, Gilbert, HC, Grap, MJ, Li, D, Medina, J, Mularski, RA, Pasero, C, Varkey, B & Sessler, CN 2009, 'Pain management principles in the critically ill', Chest, vol. 135, no. 4, pp. 1075-1086. https://doi.org/10.1378/chest.08-2264
Erstad BL, Puntillo K, Gilbert HC, Grap MJ, Li D, Medina J et al. Pain management principles in the critically ill. Chest. 2009 Apr 1;135(4):1075-1086. https://doi.org/10.1378/chest.08-2264
Erstad, Brian L ; Puntillo, Kathleen ; Gilbert, Hugh C. ; Grap, Mary Jo ; Li, Denise ; Medina, Justine ; Mularski, Richard A. ; Pasero, Chris ; Varkey, Basil ; Sessler, Curtis N. / Pain management principles in the critically ill. In: Chest. 2009 ; Vol. 135, No. 4. pp. 1075-1086.
@article{19d438b29c724b81a29c72724084391d,
title = "Pain management principles in the critically ill",
abstract = "This article addresses conventional pharmacologic and nonpharmacologic treatment of pain in patients in ICUs. For the critically ill patient, opioids have been the mainstay of pain control. The optimal choice of opioid and dosing regimen for a specific patient varies depending on factors such as the pharmacokinetics and physicochemical characteristics of an opioid and the body's handling of the opioid, concomitant sedative regimen, potential or actual adverse drug events, and development of tolerance. The clinician must appreciate that favorable pharmacokinetic properties such as a short-elimination half-life do not necessarily translate into clinical advantages in the ICU setting. A variety of medications have been proposed as alternatives or adjuncts to the opioids for pain control that have unique considerations when contemplated for use in the critically ill patient. Most have been relatively unstudied in the ICU setting, and many have limitations with respect to availability of the GI route of administration in patients with questionable GI absorptive function. Nonpharmacologic, complementary therapies are low cost, easy to provide, and safe, and many clinicians can implement them with little difficulty or resources. However, the evidence base for their effectiveness is limited. At present, insufficient research evidence is available to support a broad implementation of nonpharmacologic therapies in ICUs.",
keywords = "Analgesics, Critical care, Nonpharmacologic interventions, Opioid, Pain",
author = "Erstad, {Brian L} and Kathleen Puntillo and Gilbert, {Hugh C.} and Grap, {Mary Jo} and Denise Li and Justine Medina and Mularski, {Richard A.} and Chris Pasero and Basil Varkey and Sessler, {Curtis N.}",
year = "2009",
month = "4",
day = "1",
doi = "10.1378/chest.08-2264",
language = "English (US)",
volume = "135",
pages = "1075--1086",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "4",

}

TY - JOUR

T1 - Pain management principles in the critically ill

AU - Erstad, Brian L

AU - Puntillo, Kathleen

AU - Gilbert, Hugh C.

AU - Grap, Mary Jo

AU - Li, Denise

AU - Medina, Justine

AU - Mularski, Richard A.

AU - Pasero, Chris

AU - Varkey, Basil

AU - Sessler, Curtis N.

PY - 2009/4/1

Y1 - 2009/4/1

N2 - This article addresses conventional pharmacologic and nonpharmacologic treatment of pain in patients in ICUs. For the critically ill patient, opioids have been the mainstay of pain control. The optimal choice of opioid and dosing regimen for a specific patient varies depending on factors such as the pharmacokinetics and physicochemical characteristics of an opioid and the body's handling of the opioid, concomitant sedative regimen, potential or actual adverse drug events, and development of tolerance. The clinician must appreciate that favorable pharmacokinetic properties such as a short-elimination half-life do not necessarily translate into clinical advantages in the ICU setting. A variety of medications have been proposed as alternatives or adjuncts to the opioids for pain control that have unique considerations when contemplated for use in the critically ill patient. Most have been relatively unstudied in the ICU setting, and many have limitations with respect to availability of the GI route of administration in patients with questionable GI absorptive function. Nonpharmacologic, complementary therapies are low cost, easy to provide, and safe, and many clinicians can implement them with little difficulty or resources. However, the evidence base for their effectiveness is limited. At present, insufficient research evidence is available to support a broad implementation of nonpharmacologic therapies in ICUs.

AB - This article addresses conventional pharmacologic and nonpharmacologic treatment of pain in patients in ICUs. For the critically ill patient, opioids have been the mainstay of pain control. The optimal choice of opioid and dosing regimen for a specific patient varies depending on factors such as the pharmacokinetics and physicochemical characteristics of an opioid and the body's handling of the opioid, concomitant sedative regimen, potential or actual adverse drug events, and development of tolerance. The clinician must appreciate that favorable pharmacokinetic properties such as a short-elimination half-life do not necessarily translate into clinical advantages in the ICU setting. A variety of medications have been proposed as alternatives or adjuncts to the opioids for pain control that have unique considerations when contemplated for use in the critically ill patient. Most have been relatively unstudied in the ICU setting, and many have limitations with respect to availability of the GI route of administration in patients with questionable GI absorptive function. Nonpharmacologic, complementary therapies are low cost, easy to provide, and safe, and many clinicians can implement them with little difficulty or resources. However, the evidence base for their effectiveness is limited. At present, insufficient research evidence is available to support a broad implementation of nonpharmacologic therapies in ICUs.

KW - Analgesics

KW - Critical care

KW - Nonpharmacologic interventions

KW - Opioid

KW - Pain

UR - http://www.scopus.com/inward/record.url?scp=64749098832&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=64749098832&partnerID=8YFLogxK

U2 - 10.1378/chest.08-2264

DO - 10.1378/chest.08-2264

M3 - Article

C2 - 19349403

AN - SCOPUS:64749098832

VL - 135

SP - 1075

EP - 1086

JO - Chest

JF - Chest

SN - 0012-3692

IS - 4

ER -