Analgesia in the critically ill patient.

Pain is a major problem and primary concern of patients in the ICU. While nonintubated patients can verbalize their discomfort to healthcare providers, intubated patients cannot effectively communicate and are more at risk for inadequate analgesia. Mechanically ventilated, paralyzed patients are at even greater risk for inadequate control of pain. Compassionate care of ICU patients requires clinicians to treat a patient's pain, which, in addition to improving patient satisfaction, may improve patient outcome by attenuating the stress response. Pain arises in the periphery, when tissue destruction causes the release of biochemical agents that activate peripheral pain receptors. These receptors, in turn, initiate an impulse in A-delta and C fibers, an impulse that is carried through neurons in the spinal cord to the brainstem and cerebral cortex. Effective treatment of pain is achieved using several modalities that modify the pain impulse, either in the periphery or within the central nervous system. A number of techniques are available, ranging from nonsteroidal anti-inflammatory drugs to other techniques and medications. However, analgesia usually requires the use of exogenous opioids. The most critically ill, mechanically ventilated patient receiving controlled alveolar minute ventilation is a candidate for continuous infusion of intravenous narcotics.(ABSTRACT TRUNCATED AT 250 WORDS)