Pain control during the transition from intensive care unit to general ward

Introduction: The optimal management of pain during the transition from the intensive care unit (ICU) to general ward is challenging due to logistical issues. 

Objectives: To identify predictors of pain control during the transition from the ICU to the general ward.

Study Design: This was a cross-sectional study conducted at an academic medical center in the United States. 

Methods: Surgical/trauma patients who were discharged from the surgical ICU and admitted to the general ward were interviewed regarding their pain after 24 hours of transfer from the ICU using the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R). The primary outcome measure was the total score of this validated instrument (0 to 180 points). Pertinent data were also collected from the patients’ medical record.  Predictors of pain control were identified using linear regression analysis.

Results: A total of 50 patients were included. The mean age was 55 ± 21 years and 72% (n=36) were male. The number of surgeries patients received prior to ICU transfer was 0 (16%, n=8), 1 (42%, n=31), 2 (26%, n=13), and 3 or more (16%, n=8). The mean opioid dose was 43 ± 81 mg and the mean pain score was 5.1 ± 2.2 (0 to 10 scale) in the last 24 hours of ICU stay. After transfer from the ICU, the mean score on the APS-POQ-R was 54 ± 32 points (range 14 to 159 points).  The only significant predictor of pain control measured on the APS-POQ-R was the mean pain score in the last 24 hours of ICU stay (coefficient 7.3, 95% CI 3.8 to 10.8, p<0.001, R-squared 27%).

Conclusions: Mean pain score in the last 24 hours of ICU stay is an important predictor of pain control during the transition from ICU to ward.