Guidelines for Management of Pain in the ICU

Management of Pain in the ICU from Sun YaiCheng

Clinical Practice Guidelines for the Management of Pain in Adult Patients in the ICU

Crit Care Med 2013; 41:263–306

Pain assessment

• The Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT) are the most valid and reliable behavioral pain scales for monitoring pain in medical, postoperative, or trauma (except for brain injury) adult ICU patients who are unable to self-report and in whom motor function is intact and behaviors are observable. 
• We do not suggest that vital signs (or observational pain scales that include vital signs) be used alone for pain assessment in adult ICU patients (–2C).

Treatment of pain 

• We recommend that preemptive analgesia and/or non-pharmacologic interventions (e.g., relaxation) be administered to alleviate pain in adult ICU patients prior to invasive and potentially painful procedures (+2C).
• We recommend that intravenous (IV) opioids be considered as the first-line drug class of choice to treat non-neuropathic pain in critically ill patients (+1C).
• All available IV opioids, when titrated to similar pain intensity endpoints, are equally effective (C).
• We suggest that non-opioid analgesics be considered to decrease the amount of opioids administered (or to eliminate the need for IV opioids altogether) and to decrease opioid-related side effects (+2C).
• We recommend that either enterally administered gabapentin or carbamazepine, in addition to IV opioids, be considered for treatment of neuropathic pain (+1A).