Effective acute pain management is an essential component of contemporary critical care. This is for compelling humanitarian reasons combined with the need to minimize physiological and neurobiological changes. Increasing basic scientific and clinical evidence support pre-emptive and aggressive provision of analgesia for acute pain to minimize suffering, decrease morbidity, reduce costs, and improve outcome. Fears that pain therapies may compromise the critically ill are unfounded provided that analgesia is administered with due care and expertise.

There are many novel and sophisticated analgesic techniques that may be appropriate in difficult cases, but practitioners should not adopt approaches that are outside their experience or ability to monitor appropriately. Fortunately, careful administration of standard drugs and the application of non-drug approaches will provide excellent results in the majority of patients.

The essential component of effective pain management is constant re-evaluation with regular assessment of pain intensity and side-effects. Defining outcomes as 'normalization' of physiological variables in the unconscious patient or a score of less than 4 out of 10 on a visual or verbal analog scale in the conscious and communicating patient will assist in appropriate adjustments to treatment. Failure to achieve pain relief within the skills of the practitioner should prompt a referral to the pain management team as is normal practice with other medical problems.

An algorithm for pain management in critical care is shown in Fig !..

Fig. 1 Algorithm for pain management in critical care: VAS, visual analog scale; IV, intravenous.

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