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

Kathleen A Puntillo; Adeline Max; Jean-Francois Timsit; Stephane Ruckly; Gerald Chanques; Gemma Robleda; Ferran Roche-Campo; Jordi Mancebo; Jigeeshu V Divatia; Marcio Soares; Daniela C Ionescu; Ioana M Grintescu; Salvatore Maurizio Maggiore; Katerina Rusinova; Radoslaw Owczuk; Ingrid Egerod; Elizabeth D E Papathanassoglou; Maria Kyranou; Gavin M Joynt; Gaston Burghi; Ross C Freebairn; Kwok M Ho; Anne Kaarlola; Rik T Gerritsen; Jozef Kesecioglu; Miroslav M S Sulaj; Michelle Norrenberg; Dominique D Benoit; Myriam S G Seha; Akram Hennein; Fernando J Pereira; Julie S Benbenishty; Fekri Abroug; Andrew Aquilina; Julia R C Monte; Youzhong An; Elie Azoulay

doi:10.1007/s00134-018-5344-0

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

Kathleen A Puntillo, Adeline Max, Jean-Francois Timsit, Stephane Ruckly, Gerald Chanques, Gemma Robleda, Ferran Roche-Campo, Jordi Mancebo, Jigeeshu V Divatia, Marcio Soares, Daniela C Ionescu, Ioana M Grintescu, Salvatore Maurizio Maggiore, Katerina Rusinova, Radoslaw Owczuk, Ingrid Egerod, Elizabeth D E Papathanassoglou, Maria Kyranou, Gavin M Joynt, Gaston BurghiRoss C Freebairn, Kwok M Ho, Anne Kaarlola, Rik T Gerritsen, Jozef Kesecioglu, Miroslav M S Sulaj, Michelle Norrenberg, Dominique D Benoit, Myriam S G Seha, Akram Hennein, Fernando J Pereira, Julie S Benbenishty, Fekri Abroug, Andrew Aquilina, Julia R C Monte, Youzhong An, Elie Azoulay

Department of Clinical Medicine

9 Citations (Scopus)

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.

Original language	English
Journal	Intensive Care Medicine
Volume	44
Issue number	9
Pages (from-to)	1493-1501
Number of pages	9
ISSN	0342-4642
DOIs	https://doi.org/10.1007/s00134-018-5344-0
Publication status	Published - 1 Sept 2018

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Puntillo, K. A., Max, A., Timsit, J-F., Ruckly, S., Chanques, G., Robleda, G., Roche-Campo, F., Mancebo, J., Divatia, J. V., Soares, M., Ionescu, D. C., Grintescu, I. M., Maggiore, S. M., Rusinova, K., Owczuk, R., Egerod, I., Papathanassoglou, E. D. E., Kyranou, M., Joynt, G. M., ... Azoulay, E. (2018). Pain distress: the negative emotion associated with procedures in ICU patients. Intensive Care Medicine, 44(9), 1493-1501. https://doi.org/10.1007/s00134-018-5344-0

Puntillo, KA, Max, A, Timsit, J-F, Ruckly, S, Chanques, G, Robleda, G, Roche-Campo, F, Mancebo, J, Divatia, JV, Soares, M, Ionescu, DC, Grintescu, IM, Maggiore, SM, Rusinova, K, Owczuk, R, Egerod, I, Papathanassoglou, EDE, Kyranou, M, Joynt, GM, Burghi, G, Freebairn, RC, Ho, KM, Kaarlola, A, Gerritsen, RT, Kesecioglu, J, Sulaj, MMS, Norrenberg, M, Benoit, DD, Seha, MSG, Hennein, A, Pereira, FJ, Benbenishty, JS, Abroug, F, Aquilina, A, Monte, JRC, An, Y & Azoulay, E 2018, 'Pain distress: the negative emotion associated with procedures in ICU patients', Intensive Care Medicine, vol. 44, no. 9, pp. 1493-1501. https://doi.org/10.1007/s00134-018-5344-0

@article{543bce79bea14a5a83df8a27c6bf98b0,

title = "Pain distress: the negative emotion associated with procedures in ICU patients",

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.",

author = "Puntillo, {Kathleen A} and Adeline Max and Jean-Francois Timsit and Stephane Ruckly and Gerald Chanques and Gemma Robleda and Ferran Roche-Campo and Jordi Mancebo and Divatia, {Jigeeshu V} and Marcio Soares and Ionescu, {Daniela C} and Grintescu, {Ioana M} and Maggiore, {Salvatore Maurizio} and Katerina Rusinova and Radoslaw Owczuk and Ingrid Egerod and Papathanassoglou, {Elizabeth D E} and Maria Kyranou and Joynt, {Gavin M} and Gaston Burghi and Freebairn, {Ross C} and Ho, {Kwok M} and Anne Kaarlola and Gerritsen, {Rik T} and Jozef Kesecioglu and Sulaj, {Miroslav M S} and Michelle Norrenberg and Benoit, {Dominique D} and Seha, {Myriam S G} and Akram Hennein and Pereira, {Fernando J} and Benbenishty, {Julie S} and Fekri Abroug and Andrew Aquilina and Monte, {Julia R C} and Youzhong An and Elie Azoulay",

year = "2018",

month = sep,

day = "1",

doi = "10.1007/s00134-018-5344-0",

language = "English",

volume = "44",

pages = "1493--1501",

journal = "European Journal of Intensive Care Medicine",

issn = "0935-1701",

publisher = "Springer",

number = "9",

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TY - JOUR

T1 - Pain distress

T2 - the negative emotion associated with procedures in ICU patients

AU - Puntillo, Kathleen A

AU - Max, Adeline

AU - Timsit, Jean-Francois

AU - Ruckly, Stephane

AU - Chanques, Gerald

AU - Robleda, Gemma

AU - Roche-Campo, Ferran

AU - Mancebo, Jordi

AU - Divatia, Jigeeshu V

AU - Soares, Marcio

AU - Ionescu, Daniela C

AU - Grintescu, Ioana M

AU - Maggiore, Salvatore Maurizio

AU - Rusinova, Katerina

AU - Owczuk, Radoslaw

AU - Egerod, Ingrid

AU - Papathanassoglou, Elizabeth D E

AU - Kyranou, Maria

AU - Joynt, Gavin M

AU - Burghi, Gaston

AU - Freebairn, Ross C

AU - Ho, Kwok M

AU - Kaarlola, Anne

AU - Gerritsen, Rik T

AU - Kesecioglu, Jozef

AU - Sulaj, Miroslav M S

AU - Norrenberg, Michelle

AU - Benoit, Dominique D

AU - Seha, Myriam S G

AU - Hennein, Akram

AU - Pereira, Fernando J

AU - Benbenishty, Julie S

AU - Abroug, Fekri

AU - Aquilina, Andrew

AU - Monte, Julia R C

AU - An, Youzhong

AU - Azoulay, Elie

PY - 2018/9/1

Y1 - 2018/9/1

N2 - 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.

AB - 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.

U2 - 10.1007/s00134-018-5344-0

DO - 10.1007/s00134-018-5344-0

M3 - Journal article

C2 - 30128592

SN - 0935-1701

VL - 44

SP - 1493

EP - 1501

JO - European Journal of Intensive Care Medicine

JF - European Journal of Intensive Care Medicine

IS - 9

ER -

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

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