• Papathanassoglou Elizabeth D E EDE Elizabeth D. E. Papathanassoglou is an associate professor, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada. Maria, Maria Hadjibalassi, Panagiota Miltiadous, Ekaterini Lambrinou, Evridiki Papastavrou, Lefkios Paikousis, and Theodoros Kyprianou.
• Elizabeth D. E. Papathanassoglou is an associate professor, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada. Maria Hadjibalassi is an assistant professor Panagiota Miltiadous is special teaching staff, and Ekaterini Lambrinou and Evridiki Papastavrou are associate professors, Department of Nursing, Cyprus University of Technology, Limassol, Cyprus. Lefkios Paikousis is an analyst, Improvast Analytical Services Company, Nicosia, Cyprus. Theodoros Kyprianou is an associate professor, St Georges University of London Medical Program, University of Nicosia Medical School, Nicosia, Cyprus. papathan@ualberta.ca.
• Am. J. Crit. Care. 2018 May 1; 27 (3): 172-185.

BackgroundPain, a persistent problem in critically ill patients, adversely affects outcomes. Despite recommendations, no evidence-based nonpharmacological approaches for pain treatment in critically ill patients have been developed.ObjectivesTo investigate the effects of a multimodal integrative intervention on the incidence of pain and on secondary outcomes: intensity of pain, hemodynamic indices (systolic and mean arterial pressure, heart rate), anxiety, fear, relaxation, optimism, and sleep quality.MethodsA randomized, controlled, double-blinded repeated-measures trial with predetermined eligibility criteria was conducted. The intervention included relaxation, guided imagery, moderate pressure massage, and listening to music. The primary outcome was incidence of pain (score on Critical Care Pain Observation Tool > 2). Other outcomes included pain ratings, hemodynamic measurements, self-reported psychological outcomes, and quality of sleep. Repeated-measures models with adjustments (baseline levels, confounders) were used.ResultsAmong the 60 randomized critically ill adults in the sample, the intervention group experienced significant decreases in the incidence (P = .003) and ratings of pain (P < .001). Adjusted models revealed a significant trend for lower incidence (P = .002) and ratings (P < .001) of pain, systolic arterial pressure (P < .001), anxiety (P = .01), and improved quality of sleep (P = .02).ConclusionA multimodal integrative intervention may be effective in decreasing pain and improving pain-related outcomes in critically ill patients.© 2018 American Association of Critical-Care Nurses.

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