The Challenge of Recognizing Pain in Critically ill Patients: An Illustrative Case Report and Mini-Review

A 25-year-old man was admitted to the intensive therapy unit (ITU) following surgery for multiple injuries sustained in a severe road traffic accident. Oesophageal and tracheal injuries had been repaired. Multiple lacerations, all over his body, had been cleaned and dressed under anaesthesia. A forearm fracture was managed with a plaster of paris back slab. The rib fractures and fractured fibula were managed conservatively. The patient was brought to the ITU from the operating room with an oral endotracheal tube in situ and mechanically ventilated.
The recognition of pain in ICU patients is extremely difficult. Assessment is hampered by reduced consciousness secondary to their illness or a requirement for sedation. Studies have consistently demonstrated that pain in ICU patients is under-recognised and undertreated. Changing sedation practice may improve patient morbidity by reducing the depth of sedation, or by prioritising analgesia over sedation.

Keywords: Pain; Intensive therapy unit; Analgesia; Sedation.