Lončarić-Katušin Mirjana, Ovčar Dorian, Žilić Antonio, Kogler Jana, Radoš Ivan
Department of Anesthesiology, Resuscitation and Intensive Care Medicine, OB Karlovac, Karlovac, Croatia.
Clinic for Anesthesiology, Resuscitation and Intensive Care Medicine and Pain Therapy, Clinical Hospital Center Zagreb, Zagreb, Croatia.
Acta Clin Croat. 2023 Nov;62(Suppl4):82-87. doi: 10.20471/acc.2023.62.s4.12.
The personalization of pain treatment in intensive care units was developed due to the interindividual variability and heterogeneity of critically ill patients. A personalized approach to pain is based on the prediction and continuous assessment of pain. In critically ill patients, this approach includes the knowledge of the underlying cause of pain related to the primary diagnosis, the causes of procedural pain and previous chronic pain conditions of the patient, in order to apply a specific therapeutic approach. Available treatment recommendations emphasize the use of adaptive or dynamic analgesia, with titration of analgesics according to changes in the clinical state of patients. They indicate the necessity of pain assessment with tools for pain intensity assessment and therapy evaluation, as well as the need for assessment at regular time intervals. Despite treatment guidelines, clinical practice shows significant deviations from evidence-based recommendations. The reasons are primarily the non-recognition of pain, insufficient knowledge of analgesics (type and dose), lack of regular assessment and inadequacy of the applied tools for pain assessment. In terms of personalization, there is a need to develop objective pain assessment methods, such as sensitive and pain-specific tools that do not rely on the patient's ability to communicate and are independent of assessors, disease characteristics and pharmacological interventions in critically ill patients.
重症监护病房疼痛治疗的个性化是由于危重症患者存在个体间差异和异质性而发展起来的。个性化疼痛治疗方法基于对疼痛的预测和持续评估。对于危重症患者，这种方法包括了解与主要诊断相关的疼痛潜在原因、操作疼痛的原因以及患者先前的慢性疼痛状况，以便采用特定的治疗方法。现有的治疗建议强调采用适应性或动态镇痛，根据患者临床状态的变化调整镇痛药剂量。这些建议指出，有必要使用疼痛强度评估工具和治疗评估工具进行疼痛评估，并且需要定期进行评估。尽管有治疗指南，但临床实践显示与循证建议存在显著偏差。原因主要包括对疼痛认识不足、对镇痛药（类型和剂量）了解不够、缺乏定期评估以及所应用的疼痛评估工具不充分。在个性化方面，需要开发客观的疼痛评估方法，例如针对危重症患者的敏感且特定于疼痛的工具，这些工具不依赖患者的沟通能力，且独立于评估者、疾病特征和药物干预。
