Introduction
Pain management in the intensive care units is a major concern not only to accredited organizations but also every hospital in the United States. Most critically ill patients go through excruciating pain due to invasive procedures, injury, or primary illness. The study indicates that at least 80% of critically ill patients experience varying intensities of pain. The pain stalls the recovery process of the patients (Adam et al., 2015). The patients suffer from numerous physical and psychological disorders like neuroendocrine secretion, blood pressure, and depression. The primary objective of pain management in critically ill patients is to prevent emotional and physiological effects related to unrelieved pain. This paper will discuss the mechanisms that doctors use to alleviate pain in critically ill patients.
Background Information
Adam et al. (2015) argue, “Pain in intensive care units (ICU) triggers the physical and emotional stress response, inhibits healing, increases the risk of other complications, and the length of ICU stay” (p. 225). Pain is a major apprehension of seriously ill patients. A majority of the patients in the intensive care units suffer from temperate to intense pain. Failure to manage the pain may result in the patients developing numerous physiological and mental conditions. The patients may suffer from distress associated with post-operative pain, diagnostic tests, and invasive tubes. According to Adam et al. (2015), patients in the intensive care unit suffer from intensified cardiovascular events, ventilator dyssynchrony, and sympathetic nervous activity. Hence, there is a need to manage pain to alleviate their suffering.
Pain Management Techniques
Doctors and nurses use numerous pain management techniques to assist patients in the intensive care units. The standard method used to manage pain in ICU is the administration of analgesic medications. Medical practitioners use opioids to manage pain in patients. Carroll et al. (2005) claim that the opioids that are commonly employed in the intensive care units include fentanyl, morphine, and hydromorphone. Carroll et al. (2005) maintain, “Through binding to opioid receptors, these opioids produce analgesia and some sedation” (p. 109). The biggest problem with using analgesic medications is that they might have side effects on the patients. For instance, some patients may suffer from nausea, respiratory depression, vomiting, constipation, and bradycardiac among others.
The medical practitioners also use non-pharmacological interventions to alleviate pain among the patients in intensive care units. One of the non-pharmacological techniques is massage therapy. According to the gate-control theory of pain, massage inhibits the transfer of toxic stimuli. Adams, White, and Beckett (2010) hold that massage triggers enormous nerve fibers that modify pain acuity. Relaxation is critical in alleviating pain. Adams et al. (2010) claim that massage therapy results in relaxation response (RR), which helps in pain alleviation. The relaxation response brings forth physical transformations like reduced heart rate, minimal levels of noradrenalin and cortisol as well as low blood pressure that cause pain and suffering in critically ill patients.
Research indicates that back massage helps to alleviate pain in patients suffering from heart diseases. The Patients experience immense pain due to cardiac catheterization. According to Menefee and Monti (2005), a 20-minute massage helps to reduce pain during cardiac catheterization. Additionally, the massage minimizes blood pressure. Massage therapy prevents the occurrence of lymphoedema among patients suffering from breast cancer. Lymphoedema is a primary cause of pain among patients with breast cancer. It results in swelling in the limbs, which is excruciatingly painful. The primary objective of using non-pharmacological techniques is to cure cognitive, affective, socio-cultural and behavioral aspects of pain (Menefee & Monti, 2005). The methods serve as an adjuvant treatment. The doctors have to use the techniques together with analgesic medications.
Apart from massage therapy, the doctors perform other peripheral treatments that help to reduce pain. The doctors perform skin stimulation, which contributes to reducing pain. The skin stimulation treats the secondary diseases like edema, muscle spasm, and inflammation that cause severe pain. Other non-pharmacological techniques used include transcutaneous electrical nerve stimulation (TENS). According to Menefee and Monti (2005), TENS is a mode of skin stimulation that relies on electrical power. The doctors use TENS together with pharmacological techniques to manage heightened, persistent and post-operative pain. TENS facilitates the stimulation of the transmitting nerve fibers, therefore ending or minimizing pain transmission. Transcutaneous electrical nerve stimulation does not only help in pain management but also prevents the use of narcotic drugs. The doctors also use the hot-cold healing approach to manage pain. The hot treatment “moves the reflex arcs that inhibit the pain using heat receptors and reduces pain by vasodilatation effect” (Menefee & Monti, 2005, p. 17). Conversely, the cold treatment entails placing a cooling substance or apparatus on the body of the patient. The cold substance breaks the vicious cycle of the pain-spasm, thus relieving the patient.
Conclusion
Pain management in the intensive care units is a primary concern. Doctors use both pharmacological and non-pharmacological techniques to manage pain among patients in the intensive care units. The non-pharmacological methods include skin stimulation, TENS, and the hot-cold treatment approach. They help to arouse the transmitting nerve fibers, hence ending or diminishing pain transmission.
References
Adam, V., Matolic, M., Ilic, M., Grizelj-Stojcic, E., Smiljanic, A., & Skok, I. (2015). Pain management in critically ill patients. Periodicum Biologorum, 117(2), 225-230.
Adams, R., White, B., & Beckett, C. (2010). The effects of massage therapy on pain management in the acute care setting. International Journal of Therapeutic Massage and Bodywork, 3(1), 4-11.
Carroll, C., Atkins, P., Herold, G., Mlcek, C., Shively, M., Clopton, P., & Glaser, D. (2005). Pain assessment and management in critically ill postoperative and trauma patients: A multisite study. American Journal of Critical Care, 8(2), 105-118.
Menefee, L., & Monti, D. (2005). Non-pharmacologic and complementary approaches to cancer pain management. The Journal of the American Osteopathic Association, 105(11), 115-120.