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Updated: Jun 22, 2026
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Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
Structured approaches to pain management in the ICU
Chris Pasero1, Kathleen Puntillo2, Denise Li3
1Independent Pain Management Educator and Clinical Consultant, El Dorado Hills, CA.
Chest
|June 6, 2009
Summary
Pain management for critically ill patients is often inadequate due to complex conditions and system barriers. A multidisciplinary quality improvement approach is crucial for implementing evidence-based solutions to improve pain treatment in intensive care units (ICUs).
Area of Science:
- Critical Care Medicine
- Pain Management
- Quality Improvement
Background:
- Pain in critically ill patients is a persistent challenge, undertreated despite extensive research and educational initiatives.
- Complex medical conditions and systemic issues, including outdated practices and restrictive formularies, create significant barriers to effective pain management.
- Hospital intensive care units (ICUs) present unique obstacles to delivering optimal pain treatment.
Purpose of the Study:
- To identify common barriers to adequate pain management in the ICU setting.
- To present structured, evidence-based approaches for improving pain treatment in critically ill patients.
- To advocate for a multidisciplinary, patient-centered continuous quality improvement (CQI) process.
Main Methods:
- Review of existing literature and clinical practices related to pain management in ICUs.
- Analysis of systemic and practice-related barriers hindering effective pain relief.
- Description of structured quality improvement strategies tailored for the ICU environment.
Main Results:
- Undertreatment of pain in critically ill patients persists due to multifaceted challenges.
- Outdated practices and system flaws impede optimal pain management.
- Multidisciplinary, patient-centered CQI is identified as essential for overcoming these barriers.
Conclusions:
- Addressing undertreated pain in ICUs requires a systematic, multidisciplinary approach.
- Implementing evidence-based solutions through continuous quality improvement is vital for enhancing patient outcomes.
- Overcoming barriers necessitates a focus on patient-centered care and systemic reform within ICUs.
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