Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
J Intensive Care Med. 2013 May-Jun;28(3):140-50. doi: 10.1177/0885066611432417. Epub 2012 Jan 9.
Pain is abundant in the intensive care unit (ICU). Successful analgesia demands a comprehensive appreciation for the etiologies of pain, vigilant clinical assessment, and personalized treatments. For the critically ill, frequent threats to mental and bodily integrity magnify the experience of pain, challenging clinicians to respond swiftly and thoughtfully. Because pain is difficult to predict and physiologic correlates are not specific, self-report remains the gold standard assessment. When communication is limited by intubation or cognitive deficits, behavioral pain scales prove useful. Patient-tailored analgesia aspires to mitigate suffering while optimizing alertness and cognitive capacity. Mindfulness of the neuropsychiatric features of pain helps the ICU clinician to clarify limits of traditional analgesia and identify alternative approaches to care. Armed with empirical data and clinical practice recommendations to better conceptualize, identify, and treat pain and its neuropsychiatric comorbidities, the authors (psychiatric consultants, by trade) reinforce holistic approaches to pain management in the ICU. After all, without attempts to understand and relieve suffering on all fronts, pain will remain undertreated.
疼痛在重症监护病房（ICU）中很常见。成功的镇痛需要全面了解疼痛的病因，进行警惕的临床评估，并进行个性化治疗。对于危重病人，频繁威胁到心理和身体完整性会放大疼痛的体验，这使得临床医生必须迅速而深思熟虑地做出反应。由于疼痛难以预测，生理相关性也不明确，自我报告仍然是金标准评估。当因插管或认知障碍而限制交流时，行为疼痛量表则证明有用。针对患者的镇痛旨在减轻痛苦的同时优化警觉性和认知能力。注意疼痛的神经精神特征有助于 ICU 临床医生阐明传统镇痛的局限性，并确定护理的替代方法。作者（精神科顾问）利用经验数据和临床实践建议，更好地理解、识别和治疗疼痛及其神经精神合并症，并加强 ICU 中疼痛管理的整体方法。毕竟，如果不尝试从各个方面理解和缓解痛苦，疼痛仍将得不到充分治疗。
