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Pain in Critically Ill Older Patients

  • Marie-Madlen Jeitziner
  • Béatrice Jenni-Moser
  • Thekla Brunkert
  • Franziska Zúñiga
Chapter
Part of the Perspectives in Nursing Management and Care for Older Adults book series (PNMCOA)

Abstract

Pain is a common symptom in patients treated in an intensive care unit (ICU) and can be particularly distressing for older patients. Pain is reported by more than half of the patients treated in an ICU, and up to 75% of all medical and surgical ICU patients report the intensity of their pain as moderate to severe. Extrinsic factors such as medical and nursing treatments, or intrinsic factors such as underlying diseases, are important causes of pain. These factors are often very invasive. This chapter, which focuses on pain in critically ill older patients, shows that treating pain requires an interdisciplinary collaboration, including nurses, physicians, and the other healthcare professionals that are involved in treating patients in the ICU. The entire organization or institution must ensure the establishment of interdisciplinary pain management in order to treat pain adequately. The literature recommends using a numerical rating scale for self-assessment of pain, or a behavioral assessment scale for patients who are unable to express themselves verbally. Patient-oriented, individual treatment goals in terms of pain and analgesia management are shown to be effective in reducing pain. Pharmacological and non-pharmacological treatments help older patients reduce their pain.

Keywords

Older patients Critical care Pain 

References

  1. Baron R, Binder A, Biniek R, Braune S, Buerkle H, Dall P, Demirakca S, Eckardt R, Eggers V, Eichler I, Fietze I, Freys S, Fründ A, Garten L, Gohrbandt B, Harth I, Hartl W, Heppner HJ, Horter J, Huth R, Janssens U, Jungk C, Kaeuper KM, Kessler P, Kleinschmidt S, Kochanek M, Kumpf M, Meiser A, Mueller A, Orth M, Putensen C, Roth B, Schaefer M, Schaefers R, Schellongowski P, Schindler M, Schmitt R, Scholz J, Schroeder S, Schwarzmann G, Spies C, Stingele R, Tonner P, Trieschmann U, Tryba M, Wappler F, Waydhas C, Weiss B, Weisshaar G. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version. Ger Med Sci. 2015;13:Doc19.PubMedPubMedCentralGoogle Scholar
  2. Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, Davidson JE, Devlin JW, Kress JP, Joffe AM, Coursin DB, Herr DL, Tung A, Robinson BR, Fontaine DK, Ramsay MA, Riker RR, Sessler CN, Pun B, Skrobik Y, Jaeschke R. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263–306.CrossRefPubMedGoogle Scholar
  3. Battle CE, Lovett S, Hutchings H. Chronic pain in survivors of critical illness: a retrospective analysis of incidence and risk factors. Crit Care. 2013;17(3):R101.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Chanques G, Viel E, Constantin JM, Jung B, de Lattre S, Carr J, Cissé M, Lefrant JY, Jaber S. The measurement of pain in intensive care unit: comparison of 5 self-report intensity scales. Pain. 2010;151(3):711–21.CrossRefPubMedGoogle Scholar
  5. Gélinas C. Management of pain in cardiac surgery ICU patients. Have we improved over time? Intensive Crit Care Nurs. 2007;23(5):298–303.CrossRefPubMedGoogle Scholar
  6. Gélinas C, Johnston C. Pain assessment in the critically ill ventilated adult: validation of the critical-care pain observation tool and physiologic indicators. Clin J Pain. 2007;23(6):497–505.CrossRefPubMedGoogle Scholar
  7. Gélinas C, Arbour C, Michaud C, Robar L, Côté J. Patients and ICU nurses’ perspectives of non-pharmacological interventions for pain management. Nurs Crit Care. 2013;18(6):307–18.CrossRefPubMedGoogle Scholar
  8. Guidet B, Leblanc G, Simon T, Woimant M, Quenot JP, Ganansia O, Maignan M, Yordanov Y, Delerme S, Doumenc B, Fartoukh M, Charestan P, Trognon P, Galichon B, Javaud N, Patzak A, Garrouste-Orgeas M, Thomas C, Azerad S, Pateron D, Boumendil A. Effect of systematic intensive care unit triage on long-term mortality among critically ill elderly patients in France: a randomized clinical trial. JAMA. 2017;318(15):1450–9.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Jeitziner MM, Hamers JP, Bürgin R, Hantikainen V, Zwakhalen SM. Long-term consequences of pain, anxiety and agitation for critically ill older patients after an intensive care unit stay. J Clin Nurs. 2015a;24(17-18):2419–28.CrossRefPubMedGoogle Scholar
  10. Jeitziner MM, Zwakhalen SM, Bürgin R, Hantikainen V, Hamers JP. Changes in health-related quality of life in older patients one year after an intensive care unit stay. J Clin Nurs. 2015b;24(21-22):3107–17.CrossRefPubMedGoogle Scholar
  11. Kyranou M, Puntillo K. The transition from acute to chronic pain: might intensive care unit patients be at risk? Ann Intensive Care. 2012;2(1):36.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Morandi A, Piva S, Ely EW, Myatra SN, Salluh JIF, Amare D, Azoulay E, Bellelli G, Csomos A, Fan E, Fagoni N, Girard TD, Heras La Calle G, Inoue S, Lim CM, Kaps R, Kotfis K, Koh Y, Misango D, Pandharipande PP, Permpikul C, Cheng Tan C, Wang DX, Sharshar T, Shehabi Y, Skrobik Y, Singh JM, Slooter A, Smith M, Tsuruta R, Latronico N. Worldwide Survey of the “assessing pain, both spontaneous awakening and breathing trials, choice of drugs, delirium monitoring/management, early exercise/mobility, and family empowerment” (ABCDEF) bundle. Crit Care Med. 2017;45(11):e1111–22.CrossRefPubMedGoogle Scholar
  13. Muscedere J, Waters B, Varambally A, Bagshaw SM, Boyd JG, Maslove D, Sibley S, Rockwood K. The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis. Intensive Care Med. 2017;43(8):1105–22.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Nelson JE, Cox CE, Hope AA, Carson SS. Chronic critical illness. Am J Respir Crit Care Med. 2010;182(4):446–54.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Payen JF, Bru O, Bosson JL, Lagrasta A, Novel E, Deschaux I, Lavagne P, Jacquot C. Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med. 2001;29(12):2258–63.CrossRefPubMedGoogle Scholar
  16. Puntillo KA, Max A, Timsit JF, Vignoud L, Chanques G, Robleda G, Roche-Campo F, Mancebo J, Divatia JV, Soares M, Ionescu DC, Grintescu IM, Vasiliu IL, Maggiore SM, Rusinova K, Owczuk R, Egerod I, Papathanassoglou ED, Kyranou M, Joynt GM, Burghi G, Freebairn RC, Ho KM, Kaarlola A, Gerritsen RT, Kesecioglu J, Sulaj MM, Norrenberg M, Benoit DD, Seha MS, Hennein A, Periera FJ, Benbenishty JS, Abroug F, Aquilina A, Monte JR, An Y, Azoulay E. Determinants of procedural pain intensity in the intensive care unit: the European® study. Am J Respir Crit Care Med. 2014;189(1):39–47.PubMedGoogle Scholar
  17. Puntillo KA, Max A, Chaize M, Chanques G, Azoulay E. Patient recollection of ICU procedural pain and post ICU Burden: the memory study. Crit Care Med. 2016;44(11):1988–95.CrossRefPubMedGoogle Scholar
  18. Vincent JL, Shehabi Y, Walsh TS, Pandharipande PP, Ball JA, Spronk P, Longrois D, Strøm T, Conti G, Funk GC, Badenes R, Mantz J, Spies C, Takala J. Comfort and patient-centred care without excessive sedation: the eCASH concept. Intensive Care Med. 2016;42(6):962–71.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Wehler M. Long-term outcome of elderly patients after intensive care treatment. Med Klin Intensivmed Notfmed. 2011;106(1):29–33.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Marie-Madlen Jeitziner
    • 1
  • Béatrice Jenni-Moser
    • 1
  • Thekla Brunkert
    • 2
  • Franziska Zúñiga
    • 2
  1. 1.Department of Intensive Care MedicineUniversity Hospital Bern (Inselspital), University of BernBernSwitzerland
  2. 2.Department Public HealthPT Institute of Nursing Science, Basel UniversityBaselSwitzerland

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