PURPOSE: The intensity of procedural pain in intensive care unit (ICU) patients is well documented. However, little is known about procedural pain distress, the psychological response to pain. METHODS: Post hoc analysis of a multicenter, multinational study of procedural pain. Pain distress was measured before and during procedures (0-10 numeric rating scale). Factors that influenced procedural pain distress were identified by multivariable analyses using a hierarchical model with ICU and country as random effects. RESULTS: A total of 4812 procedures were recorded (3851 patients, 192 ICUs, 28 countries). Pain distress scores were highest for endotracheal suctioning (ETS) and tracheal suctioning, chest tube removal (CTR), and wound drain removal (median [IQRs] = 4 [1.6, 1.7]). Significant relative risks (RR) for a higher degree of pain distress included certain procedures: turning (RR = 1.18), ETS (RR = 1.45), tracheal suctioning (RR = 1.38), CTR (RR = 1.39), wound drain removal (RR = 1.56), and arterial line insertion (RR = 1.41); certain pain behaviors (RR = 1.19-1.28); pre-procedural pain intensity (RR = 1.15); and use of opioids (RR = 1.15-1.22). Patient-related variables that significantly increased the odds of patients having higher procedural pain distress than pain intensity were pre-procedural pain intensity (odds ratio [OR] = 1.05); pre-hospital anxiety (OR = 1.76); receiving pethidine/meperidine (OR = 4.11); or receiving haloperidol (OR = 1.77) prior to the procedure. CONCLUSIONS: Procedural pain has both sensory and emotional dimensions. We found that, although procedural pain intensity (the sensory dimension) and distress (the emotional dimension) may closely covary, there are certain factors than can preferentially influence each of the dimensions. Clinicians are encouraged to appreciate the multidimensionality of pain when they perform procedures and use this knowledge to minimize the patient's pain experience.

Anaesthesia Critical Care and Pain Tata Memorial Hospital Homi Bhabha National Institute Mumbai India

Anesthesia and Intensive Care Department Clinical Emergency Hospital Bucharest Romania

AP HP Réanimation Medicale et des maladies infectieuses Hôpital Bichat 75018 Paris France

Consultant Critical Care Mansoura Emergency University Hospital Mansoura Egypt

Critical Care Departmemt and Graduate Program in Medical Sciences Postgraduate Program D'Or Institute for Research and Education Rio de Janeiro Brazil

Department of Anaesthesia and Intensive Care Mater Dei Hospital Msida Malta

Department of Anaesthesia and Intensive Care Prince of Wales Hospital The Chinese University of Hong Kong Shatin Hong Kong

Department of Anaesthesiology and Intensive Care General University Hospital 1st Faculty of Medicine of Charles University Prague Czech Republic

Department of Anaesthesiology and Intensive Therapy Medical University of Gdansk Gdansk Poland

Department of Anesthesia and Intensive Care 1 Iuliu Hatieganu University of Medicine and Pharmacy Cluj Napoca Romania

Department of Anesthesia and Intensive Care Montpellier University Hopital Saint Eloi Montpellier France

Department of Anesthesiology and Intensive Care Policlinico SS Annunziata Università G d'Annunzio Chieti Pescara Chieti Italy

Department of Anesthesiology and Intensive Medicine Danube Hospital Vienna Austria

Department of Critical Care Medicine Peking University People's Hospital Beijing China

Department of Intensive Care Erasme University Hospital Université Libre de Bruxelles Brussels Belgium

Department of Intensive Care Ghent University Ghent Belgium

Department of Intensive Care Medical Centre Leeuwarden Leeuwarden The Netherlands

Department of Intensive Care Medicine and School of Population Health Royal Perth Hospital and University of Western Australia Perth Australia

Department of Intensive Care Medicine University Medical Center Utrecht Netherlands

Department of Nursing Cyprus University of Technology Limassol Cyprus

Department of Physiological Nursing University of California San Francisco 2 Koret Way Box 0610 San Francisco CA 94143 0610 USA

Department of Surgery Helsinki University Hospital Helsinki Finland

Dept of Hematology and Transfusiology National Centre of Hemostasis and Thrombosis Jessenius Faculty of Medicine in Martin Comenius University in Bratislava University Hospital Martin Martin Slovakia

Faculty of Nursing University of Alberta Edmonton Canada

ICU Hadassah Hebrew University Hospital Jerusalem Israel

ICU Maennedorf Spital Maennedorf Maennedorf Switzerland

INSERM IAME UMR 1137 Team DesCID 75018 Paris France

Intensive Care Services Hawke's Bay Hospital Hastings New Zealand

Intensive Care Unit CHU F Bourguiba Monastir Tunisia

Intensive Care Unit Hospital Maciel Sanatorio Americano Montevideo Uruguay

Intensive Care Unit Rigshospitalet University of Copenhagen Copenhagen Denmark

Medical Intensive Care Unit University of Paris Diderot Saint Louis Hospital Paris France

Outcome Research Consortium Cleveland USA

PhyMedExp INSERM CNRS University of Montpellier Montpellier France

Servei de Medicina Intensiva Hospital de Sant Pau Barcelona Spain

Servei de Medicina intensiva Hospital Verge de la Cinta Tortosa Spain

Servicio Medicina Crítica y Cuidados Intensivos Clínica Las Américas Medellín Colombia

Servico Cuidados Intensivos Hospital Santo Antonio Centro Hospitalar do Porto Porto Portugal

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