Chronic pain disorders after critical illness and ICU-acquired opioid dependence: two clinical conundra

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Abstract

Purpose of review

Is to describe the potential for patients to undergo an acute-to-chronic pain transition after ICU discharge as a result of pain they experienced in ICU and to explore the phenomenon of ICU-acquired opioid dependence. Both topics are timely, in that they can negatively influence patient recovery after critical illness and contribute to post-ICU syndrome.

Recent findings

Recognizing and treating pain in patients while they are in the ICU has always been important. However, new knowledge increases the importance of good pain management on patient welfare: recent basic science discoveries on mechanisms of chronic pain development; identification of myriad factors, occurring during the patient's hospital and ICU stay, that put patients at risk for development of chronic pain; the view that a multimodal analgesia treatment approach that is opioid sparing may be the optimum method for acute pain management. Furthermore, recent findings about ICU-acquired opioid dependence provide a foundation for promoting more rigorous assessment, prevention, and treatment of opioid withdrawal in ICU patients.

Summary

Providing sufficient analgesia to ICU patients while preventing opioid dependence and withdrawal is essential to promote comfort and rehabilitation. Obtaining this balance requires heightened ICU clinician attention and focused research.

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