• Kathleen A Puntillo, Adeline Max, Marine Chaize, Gerald Chanques, and Elie Azoulay.
• 1Department of Physiological Nursing, University of California, San Francisco School of Nursing, San Francisco, CA.2Medical field Transports, Ourson Bleu, Fontenay-Sous-Bois, France.3AP-HP, Saint-Louis Hospital, Paris, France.4Department of Anesthesiology & Critical Care Medecine Montpellier University Regional Hospital, Saint Eloi Hospital Montpellier, Montpellier, France.5Medical Intensive Care Unit, AP-HP, Saint-Louis Hospital, Paris, France.
• Crit. Care Med. 2016 Nov 1; 44 (11): 1988-1995.

ObjectiveTo assess patients' recollections of in-ICU procedural pain and its impact on post-ICU burden.DesignProspective longitudinal study of patients who underwent ICU procedures.SettingThirty-four ICUs in France and Belgium.PatientsTwo hundred thirty-six patients who had undergone ICU procedures.InterventionNone.Measurements And Main ResultsPatients were interviewed 3-16 months after hospitalization about: 1) recall of procedural pain intensity and pain distress (on 0-10 numeric rating scale); 2) current pain; that is, having pain in the past week that was not present before hospitalization; and 3) presence of traumatic stress (Impact of Events Scale). For patients who could rate recalled procedural pain intensity (n = 56) and pain distress (n = 43), both were significantly higher than their median (interquartile range) in ICU procedural pain scores (pain intensity: 5 [4-7] vs 3 [2.5-5], p < 0.001; pain distress: 5 [2-6] vs 2 [0-6], p = 0.003, respectively.) Current pain was reported in 14% of patients. When comparing patients with and without current pain, patients with current pain recalled even greater ICU procedural pain intensity and pain distress scores than patients without current pain: pain intensity, 8 (6-8) versus 5 (3.25-7); p = 0.002 and pain distress, 7 (5-8) versus 4 (2-6); p = 0.01, respectively. Patients with current pain also had significantly higher Impact of Events Scale scores than those without current pain (8.5 [3.5-24] vs 2 [0-10]; p < 0.001).ConclusionMany patients remembered ICU, with far fewer able to rate procedure-associated pain. For those able to do so, recalled pain intensity and pain distress scores were significantly greater than reported in ICU. One in seven patients was having current pain, recalling even higher ICU procedural pain scores and greater traumatic stress when compared with patients without current pain. Studies are needed to assess the impact of ICU procedural pain on post-ICU pain recall, pain status over time, and the relationship between postdischarge pain status and post-ICU burden.

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