Pain distress: the negative emotion associated with procedures in ICU patients

Kathleen A Puntillo¹, Adeline Max², Jean-Francois Timsit³, Stephane Ruckly⁴, Gerald Chanques^{5

6}, Gemma Robleda⁷, Ferran Roche-Campo⁸, Jordi Mancebo⁷, Jigeeshu V Divatia⁹, Marcio Soares¹⁰, Daniela C Ionescu^{11

12}, Ioana M Grintescu¹³, Salvatore Maurizio Maggiore¹⁴, Katerina Rusinova¹⁵, Radoslaw Owczuk¹⁶, Ingrid Egerod¹⁷, Elizabeth D E Papathanassoglou^{18

19}, Maria Kyranou¹⁸, Gavin M Joynt²⁰, Gaston Burghi²¹, Ross C Freebairn²², Kwok M Ho²³, Anne Kaarlola²⁴, Rik T Gerritsen²⁵, Jozef Kesecioglu²⁶, Miroslav M S Sulaj^{27

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

Affiliations

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.

PMID: 30128592
DOI: 10.1007/s00134-018-5344-0

Free article

Multicenter Study

Pain distress: the negative emotion associated with procedures in ICU patients

Kathleen A Puntillo et al. Intensive Care Med. 2018 Sep.

Free article

. 2018 Sep;44(9):1493-1501.

doi: 10.1007/s00134-018-5344-0. Epub 2018 Aug 21.

Authors

Affiliations

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.

PMID: 30128592
DOI: 10.1007/s00134-018-5344-0

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.

Keywords: ICU; Pain distress; Procedures.

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Pain distress: the negative emotion associated with procedures in ICU patients

Affiliations

Pain distress: the negative emotion associated with procedures in ICU patients

Authors

Affiliations

Abstract

References

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