Pain Assessment and Management in Intensive Care Unit: Pharmacological and non-Pharmacological Approaches

Abstract

Background: The assessment and management of pain in Intensity Care Unit (ICU) consist a constant fact and requires various therapeutic approaches for the restriction of pain with the narrowest possible range of adverse effects. Objective: The main objective of the article is the clear definition of the pain assessment methods and the pharmacological and non-pharmacological interventions for the pain management, taking into account the pros and cons of each approach. Material and Method: A literature review was conducted on both Greek and English languages, through PubMed, Scopus, Science Direct και Google Scholar databases, using the key-words like “Pain Management in ICU”, “Non-Pharmacological Pain Management in ICU”, “Pain Recognition”, “Pain Assessment”. Results: Coping with pain is a matter with multiple levels, since its management could improve various other parameters, like anxiety, stress, sedation and the recovery and exit from ICU. Fundamental part of that is the assessment of pain, timely and in accurate manner, especially in cases where the correspondence with the patient is not possible. It is of high importance the pharmaceutical regimen to be optimal and bear limited range of side effects and tolerance-dependence, especially in hemodynamically unstable patients, where the identification of instability between drug side effects and pathological disorder is often not feasible. Apart from the pharmaceutical approaches, other methods of achieving analgesia could, at least in an auxiliary way, contribute clinically to a significant extent, limiting the intensity of side effects like repression or stimulation of the central nervous system, which in long run many analgesics cause. Conclusions: The multimodal approach of pain management with active substances or non-pharmacological methods could lead to the more effective recovery and treatment in ICU patients. Although, the majority of such therapeutic interventions there is much work to be done on this field, with the main goal the non-opioid drug devilment and the non-pharmacological approaches, for the relieve of the dependence and tolerance effects.