Evaluation and Management of Acute Pain in the Intensive Care Unit: A Single-Center Study at the Essos Hospital Centre, a Leading Referral Hospital in Cameroon
Background: Acute pain management in the Intensive Care Unit (ICU) is a major concern for patient comfort, recovery, and long-term outcomes. However, practices vary, and limited data exist on the effectiveness of pain management protocols in low-income countries such as Cameroon, particularly in leading referral hospitals like the Essos Hospital Centre. Methods: A prospective, single-center cohort study was conducted at the Essos Hospital Centre, a leading referral hospital in Cameroon. The aim was to assess the adequacy of pain assessment tools, pharmacological and non-pharmacological interventions, and the impact of pain management on patient recovery. Data were collected over a 3-month period from 130 ICU patients. Results: Preliminary findings indicate that pain assessment is inadequate, with only 60% of patients receiving systematic pain assessments. Analgesics were administered in 78% of cases, with opioids being the most commonly used (65%), followed by non-opioid analgesics (53%). Despite these interventions, 35% of patients reported moderate to severe pain during their ICU stay. A significant correlation was observed between optimal pain management and a reduced ICU stay duration (p < 0.05), as well as improved post-hospital recovery outcomes. Conclusion: This study highlights gaps in pain management practices at the Essos Hospital Centre, a leading referral hospital in Cameroon. It suggests that current protocols may not provide effective pain relief for ICU patients. We recommend the implementation of more structured pain management protocols, incorporating both pharmacological and non-pharmacological strategies, to improve both patient comfort and clinical outcomes.
References
[1]
Mears, L. and Mears, J. (2023) The Pathophysiology, Assessment, and Management of Acute Pain. British Journal of Nursing, 32, 58-65. https://doi.org/10.12968/bjon.2023.32.2.58
[2]
Lindenbaum, L. and Milia, D.J. (2012) Pain Management in the ICU. Surgical Clinics of North America, 92, 1621-1636. https://doi.org/10.1016/j.suc.2012.08.013
[3]
Back, M., Lee, W. and Aldridge, D. (2024) Pain Management in ICU: All Smoke and Mirrors? Anaesthesia, 79, 662-662. https://doi.org/10.1111/anae.16243
[4]
Amaechi, O., Huffman, M.M. and Featherstone, K. (2021) Pharmacologic Therapy for Acute Pain. American Family Physician, 104, 63-72.
[5]
Dunwoody, C.J., Krenzischek, D.A., Pasero, C., Rathmell, J.P. and Polomano, R.C. (2008) Assessment, Physiological Monitoring, and Consequences of Inadequately Treated Acute Pain. Journal of PeriAnesthesia Nursing, 23, S15-S27. https://doi.org/10.1016/j.jopan.2007.11.007
[6]
Rech, M.A., Griggs, C., Lovett, S. and Motov, S. (2022) Acute Pain Management in the Emergency Department: Use of Multimodal and Non-Opioid Analgesic Treatment Strategies. The American Journal of Emergency Medicine, 58, 57-65. https://doi.org/10.1016/j.ajem.2022.05.022
[7]
Hämäläinen, J., Kvist, T. and Kankkunen, P. (2022) Acute Pain Assessment Inadequacy in the Emergency Department: Patients’ Perspective. Journal of Patient Experience, 9. https://doi.org/10.1177/23743735211049677
[8]
Zakeri, H., Mahtosh, P., Radmehr, M., Rahbani, R., Montazeri, L., Moalemi, S., et al. (2024) Pain Management Strategies in Intensive Care Unit: Challenges and Best Practice. Galen Medical Journal, 13, e3264. https://doi.org/10.31661/gmj.v13i.3264
[9]
Gan, T.J. (2017) Poorly Controlled Postoperative Pain: Prevalence, Consequences, and Prevention. Journal of Pain Research, 10, 2287-2298. https://doi.org/10.2147/jpr.s144066
[10]
Gan, T.J., Habib, A.S., Miller, T.E., White, W. and Apfelbaum, J.L. (2013) Incidence, Patient Satisfaction, and Perceptions of Post-Surgical Pain: Results from a US National Survey. Current Medical Research and Opinion, 30, 149-160. https://doi.org/10.1185/03007995.2013.860019
[11]
Buvanendran, A., Fiala, J., Patel, K.A., Golden, A.D., Moric, M. and Kroin, J.S. (2015) The Incidence and Severity of Postoperative Pain Following Inpatient Surgery. Pain Medicine, 16, 2277-2283. https://doi.org/10.1111/pme.12751
[12]
Stanik-Hutt, J., Soeken, K., Belcher, A., Fontaine, D. and Gift, A. (2001) Pain Experiences of Traumatically Injured Patients in a Critical Care Setting. American Journal of Critical Care, 10, 252-259. https://doi.org/10.4037/ajcc2001.10.4.252
[13]
Sakr, Y., Jaschinski, U., Wittebole, X., Szakmany, T., Lipman, J., Ñamendys-Silva, S.A., et al. (2018) Sepsis in Intensive Care Unit Patients: Worldwide Data from the Intensive Care over Nations Audit. Open Forum Infectious Diseases, 5, ofy313. https://doi.org/10.1093/ofid/ofy313
[14]
Kontou, P., Kotoulas, S., Kalliontzis, S., Synodinos-Kamilos, S., Akritidou, S., Kaimakamis, E., et al. (2022) Evaluation of Pain Scales and Outcome in Critically Ill Patients of a Greek ICU. Journal of Pain & Palliative Care Pharmacotherapy, 37, 34-43. https://doi.org/10.1080/15360288.2022.2149668
[15]
Moran, B.L., Scott, D.A., Holliday, E., Knowles, S., Saxena, M., Seppelt, I., et al. (2022) Pain Assessment and Analgesic Management in Patients Admitted to Intensive Care: An Australian and New Zealand Point Prevalence Study. Critical Care and Resuscitation, 24, 224-232. https://doi.org/10.51893/2022.3.oa1
[16]
O’Neill, A. and Lirk, P. (2022) Multimodal Analgesia. Anesthesiology Clinics, 40, 455-468. https://doi.org/10.1016/j.anclin.2022.04.002
[17]
Freo, U. (2022) Paracetamol for Multimodal Analgesia. Pain Management, 12, 737-750. https://doi.org/10.2217/pmt-2021-0116
[18]
Beverly, A., Kaye, A.D., Ljungqvist, O. and Urman, R.D. (2017) Essential Elements of Multimodal Analgesia in Enhanced Recovery after Surgery (ERAS) Guidelines. Anesthesiology Clinics, 35, e115-e143. https://doi.org/10.1016/j.anclin.2017.01.018
[19]
Pota, V., Coppolino, F., Barbarisi, A., Passavanti, M.B., Aurilio, C., Sansone, P., et al. (2022) Pain in Intensive Care: A Narrative Review. Pain and Therapy, 11, 359-367. https://doi.org/10.1007/s40122-022-00366-0
[20]
Sandvik, R.K., Olsen, B.F., Rygh, L. and Moi, A.L. (2020) Pain Relief from Nonpharmacological Interventions in the Intensive Care Unit: A Scoping Review. Journal of Clinical Nursing, 29, 1488-1498. https://doi.org/10.1111/jocn.15194
[21]
Nordness, M.F., Hayhurst, C.J. and Pandharipande, P. (2021) Current Perspectives on the Assessment and Management of Pain in the Intensive Care Unit. Journal of Pain Research, 14, 1733-1744. https://doi.org/10.2147/jpr.s256406
[22]
National Academies of Sciences, Engineering and Medicine, Health and Medicine Division, Board on Health Sciences Policy, Phillips, J.K., Ford, M.A., Bonnie, R.J., et al. (2017) Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. National Academies Press.
[23]
Olsen, B.F., Rustøen, T., Sandvik, L., Jacobsen, M. and Valeberg, B.T. (2016) Results of Implementing a Pain Management Algorithm in Intensive Care Unit Patients: The Impact on Pain Assessment, Length of Stay, and Duration of Ventilation. Journal of Critical Care, 36, 207-211. https://doi.org/10.1016/j.jcrc.2016.07.011
[24]
Chanques, G. and Gélinas, C. (2022) Monitoring Pain in the Intensive Care Unit (ICU). Intensive Care Medicine, 48, 1508-1511. https://doi.org/10.1007/s00134-022-06807-w
