• 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, Papathanassoglou Elizabeth D E EDE Department of Nursing, Cyprus University of Technology, Limassol, Cyprus. , Maria Kyranou, Gavin M Joynt, Gaston Burghi, Ross C Freebairn, Kwok M Ho, Anne Kaarlola, Rik T Gerritsen, Jozef Kesecioglu, Sulaj Miroslav M S MMS Dept. of Hematology and Transfusiology, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University , Michelle Norrenberg, Dominique D Benoit, Seha Myriam S G MSG ICU Maennedorf, Spital Maennedorf, Maennedorf, Switzerland., Akram Hennein, Fernando J Pereira, Julie S Benbenishty, Fekri Abroug, Andrew Aquilina, Julia R C Monte, Youzhong An, and Elie Azoulay.
• Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA, 94143-0610, USA. kathleen.puntillo@ucsf.edu.
• Intensive Care Med. 2018 Sep 1; 44 (9): 1493-1501.

PurposeThe 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.MethodsPost 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.ResultsA 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.ConclusionsProcedural 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.

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