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Medline ® Abstract for Reference 55

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

Evaluation of pain in ICU patients.
Puntillo K, Pasero C, Li D, Mularski RA, Grap MJ, Erstad BL, Varkey B, Gilbert HC, Medina J, Sessler CN
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.
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