Pain has been found to be a major stressor1,2 and patients’ worst memory of critical care.3 Many patients erroneously believe that pain is to be expected and endured, or are fearful that use of opioid analgesics will lead to addiction. Individual healthcare providers may be unaware of patients’ discomfort or of the harmful physiological effects of unrelieved pain. It is important to recognize that despite our many advances in healthcare, unrelieved pain remains a problem.

The first step to solving this problem is to recognize pain. Assume that all critically ill patients are in pain or are at high risk for pain. Pain can be triggered by many medical conditions including ischemia, infections, inflammation, edema, and distention. Immobilization, incisions, wounds, and the use of invasive and noninvasive medical devices can also cause pain. In addition, many...

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