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

(2018) INTENSIVE CARE MEDICINE. 44(9). p.1493-1501
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Abstract
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. 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. 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. 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.
Keywords
ICU, Procedures, Pain distress, INTENSIVE-CARE-UNIT, CLINICAL PAIN, RATING-SCALES, SYMPTOMS, MECHANISMS, EXPERIENCE, ADULTS, REST

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MLA
Puntillo, Kathleen A, Adeline Max, Jean-François Timsit, et al. “Pain Distress : the Negative Emotion Associated with Procedures in ICU Patients.” INTENSIVE CARE MEDICINE 44.9 (2018): 1493–1501. Print.
APA
Puntillo, K. A., Max, A., Timsit, J.-F., Ruckly, S., Chanques, G., Robleda, G., Roche-Campo, F., et al. (2018). Pain distress : the negative emotion associated with procedures in ICU patients. INTENSIVE CARE MEDICINE, 44(9), 1493–1501.
Chicago author-date
Puntillo, Kathleen A, Adeline Max, Jean-François Timsit, Stephane Ruckly, Gerald Chanques, Gemma Robleda, Ferran Roche-Campo, et al. 2018. “Pain Distress : the Negative Emotion Associated with Procedures in ICU Patients.” Intensive Care Medicine 44 (9): 1493–1501.
Chicago author-date (all authors)
Puntillo, Kathleen A, Adeline Max, Jean-François 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 DE Papathanassoglou, Maria Kyranou, Gavin M Joynt, Gaston Burghi, Ross C Freebairn, Kwok M Ho, Anne Kaarlola, Rik T Gerritsen, Jozef Kesecioglu, Miroslav MS Sulaj, Michelle Norrenberg, Dominique Benoit, Myriam SG Seha, Akram Hennein, Fernando J Pereira, Julie S Benbenishty, Fekri Abroug, Andrew Aquilina, Julia RC Monte, Youzhong An, and Elie Azoulay. 2018. “Pain Distress : the Negative Emotion Associated with Procedures in ICU Patients.” Intensive Care Medicine 44 (9): 1493–1501.
Vancouver
1.
Puntillo KA, Max A, Timsit J-F, Ruckly S, Chanques G, Robleda G, et al. Pain distress : the negative emotion associated with procedures in ICU patients. INTENSIVE CARE MEDICINE. 2018;44(9):1493–501.
IEEE
[1]
K. A. Puntillo et al., “Pain distress : the negative emotion associated with procedures in ICU patients,” INTENSIVE CARE MEDICINE, vol. 44, no. 9, pp. 1493–1501, 2018.
@article{8585839,
  abstract     = {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. 
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. 
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. 
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 Max, Adeline and Timsit, Jean-François and Ruckly, Stephane and Chanques, Gerald and Robleda, Gemma and Roche-Campo, Ferran and Mancebo, Jordi and Divatia, Jigeeshu V and Soares, Marcio and Ionescu, Daniela C and Grintescu, Ioana M and Maggiore, Salvatore Maurizio and Rusinova, Katerina and Owczuk, Radoslaw and Egerod, Ingrid and Papathanassoglou, Elizabeth DE and Kyranou, Maria and Joynt, Gavin M and Burghi, Gaston and Freebairn, Ross C and Ho, Kwok M and Kaarlola, Anne and Gerritsen, Rik T and Kesecioglu, Jozef and Sulaj, Miroslav MS and Norrenberg, Michelle and Benoit, Dominique and Seha, Myriam SG and Hennein, Akram and Pereira, Fernando J and Benbenishty, Julie S and Abroug, Fekri and Aquilina, Andrew and Monte, Julia RC and An, Youzhong and Azoulay, Elie},
  issn         = {0342-4642},
  journal      = {INTENSIVE CARE MEDICINE},
  keywords     = {ICU,Procedures,Pain distress,INTENSIVE-CARE-UNIT,CLINICAL PAIN,RATING-SCALES,SYMPTOMS,MECHANISMS,EXPERIENCE,ADULTS,REST},
  language     = {eng},
  number       = {9},
  pages        = {1493--1501},
  title        = {Pain distress : the negative emotion associated with procedures in ICU patients},
  url          = {http://dx.doi.org/10.1007/s00134-018-5344-0},
  volume       = {44},
  year         = {2018},
}

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