Patients' perceptions and responses to procedural pain: results from Thunder Project II

Abstract

BACKGROUND: Little is known about the painfulness of procedures commonly performed in acute and critical care settings. OBJECTIVE: To describe pain associated with turning, wound drain removal, tracheal suctioning, femoral catheter removal, placement of a central venous catheter, and nonburn wound dressing change and frequency of use of analgesics during procedures. METHODS: A comparative, descriptive design was used. Numeric rating scales were used to measure pain intensity and procedural distress; word lists, to measure pain quality. RESULTS: Data were obtained from 6201 patients: 176 younger than 18 years and 5957 adults. Mean pain intensity scores for turning and tracheal suctioning were 2.80 and 3.00, respectively (scale, 0-5), for 4- to 7-year-olds and 52.0 and 28.1 (scale, 0-100) for 8- to 12-year-olds. For adolescents, mean pain intensity scores for wound dressing change, turning, tracheal suctioning, and wound drain removal were 5 to 7 (scale, 0-10); mean procedural distress scores were 4.83 to 6.00 (scale, 0-10). In adults, mean pain intensity scores for all procedures were 2.65 to 4.93 (scale, 0-10); mean procedural distress scores were 1.89 to 3.47 (scale, 0-10). The most painful and distressing procedures were turning for adults and wound care for adolescents. Procedural pain was often described as sharp, stinging, stabbing, shooting, and awful. Less than 20% of patients received opiates before procedures. CONCLUSIONS: Procedural pain varies considerably and is procedure specific. Because procedures are performed so often, more individualized attention to preparation for and control of procedural pain is warranted.

The effect of music on discomfort experienced by intensive care unit patients during turning: A randomized cross‐over study

“…[3][4][5][6][7] The most painful procedure reported by about 6000 acute and critically ill adult patients in the US Thunder II study was being turned. 1 This was supported in a recent Australian study where results from 61 conscious ICU patients indicated that postural change was one of the routine procedures causing pain. 8 This activity happens every 2-3 h in most ICU, thus it is likely experienced by a significant proportion of ICU patients on a daily basis.…”

“…NRS correlate well with Likert-type measures of pain intensity from 0.65 to 0.88 18 and are easy to administer and score and produce higher rates of correct responses. 11 Puntillo et al 1 used NRS in their large Thunder II study and report that construct and concurrent validities have been established.…”

“…Critically ill patients commonly experience anxiety, pain and discomfort as part of their intensive care unit (ICU) stay. 1,2 These experiences can be a result of their illness or from the care health professionals provide. Furthermore, being subject to numerous procedures common in the ICU such as turning, endotracheal suctioning and wound care can also adversely affect patients.…”

“…Furthermore, being subject to numerous procedures common in the ICU such as turning, endotracheal suctioning and wound care can also adversely affect patients. 1 Discomfort and anxiety have the potential to lengthen ventilator weaning time and ultimately lengthen ICU stay. The pain associated with these procedures can result in a number of negative stress sequela for patients that can be detrimental to their health and well-being.…”

Care related pain in hospitalized patients: A cross‐sectional study

“…Moreover, surveys of pain among these departments focus on procedures known as potentially painful. Other studies have thoroughly described the pain related to a few specific procedures (Puntillo et al, 2001(Puntillo et al, , 2002Li and Puntillo, 2004;Gelinas et al, 2004). Except in those situations, little scientific information is currently available about painful procedures or about the intensity or frequency of the pain they cause.…”