Unrelieved Acute Pain

Pain is a symptom, it is a subjective personal experience or a perception of an unpleasant physiological reaction caused by the existing or potential tissue damage. (Hudspith et al. 2006) (Frampton and Hughes-Webb, 2011).

The physical and mental health of patients can affect pain and, in contrast, is affected by pain.

To stimulate and raise awareness of different aspects of pain on a global level , concept of pain relief as a fundamental human right has proposed by the International Association for the Study of Pain (IASP) as a part of the Declaration of Montreal in 2007 (Collett et al. 2007).

Critically ill patients usually experience significant levels of pain and discomfort due to multiple intrinsic and extrinsic sources while they are

Optimizing pain control could affect in patients’ clinical outcome (6, 7). On the other hand,

Unrelieved acute pain causes rising in negative physiologic and psychological events that can be damage to clinical outcomes of critically ill patient.11,29,35

As a result of such findings, the use of analgesic as well as sedative drugs for critically ill patients has increased and frequently is ordered on an “as-needed” basis regardless of the specific requirements (5). However, the appropriate depth of analgesia and its efficacy scarcely have been addressed in order to go along with an “as-needed” approach.

Pain assessment is the first step in proper pain management.

For decades, many subjective measures of pain have been developed. As a consequent, these subjective measures produce consistent and reliable results when used properly and appropriately.

In unidimensional pain scales, the three most commonly used methods are the categorical verbal rating scale (VRS), numerical pain rating scale (NPRS) and visual analogue scale (VAS) (Frampton and Hughes-Webb,2011).They are all well validated in the cancer pain population (Caraceni et al.

Two measures (ie, BPS, CPOT) designed for use with intubated patients added ventilator compliance as an indicator of pain. Several studies have associated pain with mechanical ventilation and its interventions (eg, endotracheal suctioning).22,27,32 Since a number of factors unrelated to pain can affect patients’ breathing patterns with the ventilator, studies are needed to develop well defined descriptors that can increase the specificity and interrater reliability of this behavioral pain response.

About physiologic dimension, 2 objective pain instruments (PAIN Algorithm, NVPS) are designed to use in critically ill patient and included the physiologic dimension of pain. The physiologic characters used in these 2 measures were increased HR and BP. Clinical studies have established that physiologic responses are valid indicators of nociception in critically ill neonates39,40 and anesthetized adult volunteers.17 In addition, stability of these autonomic responses were shown to reflect balanced anesthesia and adequacy of analgesia during intubation procedures.12 Of the 2 objective pain measures that evaluated HR and BP responses, the PAIN Algorithm did not describe the criterion for an increase in HR or BP, whereas the NVPS parameters for a HR and BP increase did not demonstrate