Pain measurement techniques: spotlight on mechanically ventilated patients

Abstract

BackgroundProcedural pain is a frequent problem in intensive care units (ICUs). For that, pain assessment has been increasingly introduced to the ICU professional’s routine, and studies have been developed to show the relevance of measuring pain in critically ill patients.ObjectiveThis review aimed to describe pain measurement techniques for mechanically ventilated adult patients based on evidence and already published.MethodSystematic literature search was performed on PubMed and Google Scholar. Keywords “pain”, “pain measurement”, “intensive care units” and “respiration, artificial” were combined to the Boolean operator AND. No language or publication year was limited in this search. The purpose and method of all papers were analyzed and only studies which described pain assessment in mechanically ventilated patients were included in this review.ResultsObjective methods were found in the literature to assess pain in mechanically ventilated adults. Behavioral scales were the most used method for pain measurement in noncommunicative patients. Vital signs were used, but the reliability of this method was questioned. Pupillometry, bispectral index and skin conductance were found and described as pain assessment methods.ConclusionThis review showed that objective measures, as behavioral scales, are the gold standard tools to measure pain intensity in noncommunicative subjects. These data contribute to professionals’ knowledge about ICU pain measurement and emphasize its importance and consequences for adequate pain management.

MEYE: Web App for Translational and Real-Time Pupillometry

“…Light level is the primary determinant of pupil size, although non-light-driven pupil fluctuations, widely assumed as an indicator of arousal through locus coeruleus activity, can be used to index brain state across species ( McGinley et al, 2015 ; Lee and Margolis, 2016 ; Reimer et al, 2016 ). Higher cognitive and emotional processes are also able to evoke tonic or phasic pupillary changes, such as attention ( Binda et al, 2013a ), memory load ( Wierda et al, 2012 ), novelty ( Angulo-Chavira et al, 2017 ; Krebs et al, 2018 ; Montes-Lourido et al, 2021 ), pain ( Connelly et al, 2014 ; Azevedo-Santos and DeSantana, 2018 ; Charier et al, 2019 ), and more general cortical sensory processing ( Binda et al, 2013b ; Lee and Margolis, 2016 ) in humans and in animal models.…”

Intensivpasienter må kartlegges systematisk for smerter

“…Det forskes i dag også på om man kan kartlegge smerter med mer tekniske hjelpemidler enn det å observere atferden hos denne pasientgruppen (19). En metode er å bruke pupillereaksjon hos pasienten.…”

Translation into Spanish and Cultural Adaptation of the Critical-Care Pain Observation Tool

“…7 The CPOT was originally developed in French and has been translated into several languages. [8][9][10][11][12][13][14][15][16][17] To our knowledge, however, the only Spanish version of the CPOT has not undergone a formal translation process. 18,19 We describe here the process of translating into the target language-Spanish-and culturally adapting the original French version of the CPOT.…”