Guideline sources The following summarized guidelines for the evaluation and management of ICU-associated pain are prepared by our editorial team based on guidelines from the Society of Critical Care Medicine (SCCM 2022; 2013). 1 2 Guidelines 1. Screening and diagnosis Monitoring for pain: monitor pain routinely in all adult patients hospitalized in the ICU. B 2. Medical management Analgesia prior to invasive procedures: consider preemptive analgesic therapy and/or nonpharmacologic interventions prior to performing invasive and potentially painful procedures in adult ICU patients. C Management of non-neuropathic pain: Use intravenous opioids as first-line therapy for the management of non-neuropathic pain in critically ill patients. B https://web.pathway.md/diseases/recAqwELYTyYCXXXK 1/2 6/24/23, 2:27 PM ICU-associated pain Pathway Consider using nonopioid analgesics to decrease the amount of opioids administered (or to eliminate the need for intracvenous opioids altogether) and to decrease opioid-related side effects. C Managagement of neuropathic pain: consider either enterally administered gabapentin or carbamazepine, in addition to intravenous opioids, for treatment of neuropathic pain. B 3. Therapeutic procedures Neuraxial analgesia: Consider thoracic epidural analgesia for postoperative pain relief in patients undergoing AAA surgery. B Consider thoracic epidural analgesia for patients with traumatic rib fractures. C 4. Specific circumstances Pediatric patients: consider obtaining routine pain assessment via self-report using the Visual Analog Scale, NRS, Oucher Scale, or Wong-Baker Faces pain scale in critically ill pediatric patients aged 6 years capable of communicating. C Show 10 more References 1. Barr J, Fraser GL, Puntillo K et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013 Jan;41 1 263 306. Open 2. Heidi A B Smith, James B Besunder, Kristina A Betters et al. 2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility. Pediatr Crit Care Med. 2022 Feb 1;23 2):e74-e110. Open 3. Christina J Hayhurst, Jim C Jackson, Kristin R Archer et al. Pain and Its Long-term Interference of Daily Life After Critical Illness. Anesth Analg. 2018 Sep;127 3 690 697. Open 4. Ayahiro Yamashita, Masaki Yamasaki, Hiroki Matsuyama et al. Risk factors and prognosis of pain events during mechanical ventilation: a retrospective study. J Intensive Care. 2017 Feb 8;5 17. Open https://web.pathway.md/diseases/recAqwELYTyYCXXXK 2/2