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Medline ® Abstract for Reference 55

of 'Palliative care: Issues in the intensive care unit in adults'

55
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Evaluation of pain in ICU patients.
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Puntillo K, Pasero C, Li D, Mularski RA, Grap MJ, Erstad BL, Varkey B, Gilbert HC, Medina J, Sessler CN
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Chest. 2009 Apr;135(4):1069-74.
 
Pain is a common and distressing symptom in ICU patients. Yet a major challenge exists in assessing and evaluating the pain. Although the patient's self-report of pain is the "gold standard" for pain assessment, other methods must be considered when patients are unable to self-report. Currently only two pain behavior instruments have been tested for their reliability, validity, and feasibility of use in ICUs: the pain behavior scale and the Critical-Care Pain Observation Tool. Other tools, albeit with less validity testing, include the pain assessment, intervention, and notation (PAIN) algorithm and a pain behaviors checklist. When established tools are insufficient to evaluate a patient's pain, alternative methods of augmenting a pain evaluation should be considered. These can include the completion of a pain risk profile, use of surrogates, or performance of an analgesic trial. Meticulous attention to the evaluation of a critically ill patient's pain provides the basis for selection of pain interventions and the subsequent assessment of the intervention's effectiveness.
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Critical Care/Trauma Program, Department of Physiological Nursing, 2 Koret Way, University of California-San Francisco, CA 94143-0610, USA. kathleen.puntillo@nursing.ucsf.edu
PMID