Topic: - Impact of untreated pain on rehabilitation outcomes in

critical care patients.

Introduction
Despite several decades of research, pain is still a significant problem for critically ill
patients throughout their stay in the intensive care unit (ICU). Inaccurate pain
assessment and the resulting inadequate treatment of pain in critically ill adults can
have significant physiological and psychological consequences. Under diagnosed pain
has been linked to a number of adverse outcomes including increased infection rate,
prolonged mechanical ventilation, hemodynamic derangements, delirium, and
compromised immunity .( K., Pasero C., Li Puntillo D., 2009). Appropriate pain
management depends on the systematic and comprehensive assessment of pain to
guide decision-making regarding titration of analgesia and administration of “as
needed” medications (Kwekkeboom K. L., Herr K.2001;13).

Background
More points to be added.

Methods
For this literature review, relevant literature published between 2009 and 2024 was
searched using various databases, including CINAHL, MEDLINE, PsycINFO. The search
terms included “intensive care unit”, “Critical care unit”, “ Rehabilitation”, “Pain”,”
Untreated pain”, “untreated pain”, “Ventilated patients” “Intubated patients”, “Patient
outcome”. The search was limited to full text pdf articles which were published in
English. Both quantitative and qualitative studies were considered. Studies were
extracted according to the Preferred Reporting Items for Systematic Reviews and Meta
analyses (PRISMA) guidelines. A quality assessment was under taken for the each of the
included studies using Critical Appraisal Skills Programme (CASP) checklists.

Results
More points to be added.

Preferred reporting items for systematic reviews and meta analysis

(PRISMA)
More points to be added.
  Impact of untreated pain on functional recovery
Untreated pain in the intensive care unit (ICU) is a significant concern,
impacting functional recovery, rehabilitation outcomes, and long-term quality of life for
ICU survivors. Factors contributing to untreated pain include underutilization of
analgesics, inadequate dosing, fear of opioid-related adverse effects, challenges in pain
assessment, and barriers to communication between patients and healthcare providers.
Untreated pain can lead to muscle weakness, delayed rehabilitation initiation, impaired
mobility, reduced rehabilitation adhesion, prolonged hospital stays, and long-term
functional decline and disability. Chronic pain syndromes, psychological distress, sleep
disturbances, fatigue, and impaired social functioning can also be developed in ICU
survivors.

To address untreated pain, comprehensive pain assessment, multimodal analgesia, and

interdisciplinary collaboration are essential strategies. Implementing systematic
approaches to pain assessment, utilizing multimodal analgesic regimens, and facilitating
interdisciplinary collaboration among healthcare providers can optimize pain control
and promote early mobilization and rehabilitation. By optimizing pain management
throughout the continuum of critical illness and recovery, healthcare providers can
enhance patient outcomes, improve quality of life, and promote long-term recovery and
well-being among ICU survivors. (Puntillo & Naidu, 2016).

More points to be added

 Impact of untreated pain on rehabilitation outcomes

Reduced Rehabilitation Adherence: Patients experiencing untreated pain may
exhibit decreased motivation, compliance, and participation in rehabilitation sessions,
compromising the effectiveness of rehabilitation interventions and impeding progress
towards recovery goals (Fletcher et al., 2012).

Prolonged Length of Stay: Untreated pain during critical illness has been
associated with prolonged ICU and hospital lengths of stay, reflecting delayed recovery,
increased healthcare resource utilization, and higher healthcare costs (Payen et al.,
2007).

More points to be added

 Impact of untreated pain on long term quality of life

ICU survivors who experience untreated pain during critical illness are at risk of
developing chronic pain syndromes, psychological distress, anxiety, depression,
and post-traumatic stress disorder (PTSD), negatively impacting their overall
quality of life and well-being (Jackson et al., 2015).
 Untreated pain can disrupt sleep patterns, exacerbate fatigue, and impair
cognitive function, contributing to persistent physical and psychological
symptoms that affect patients' daily functioning and quality of life post-ICU
discharge (Schofield-Robinson et al., 2018).

More points to be added

 Strategies to address untreated pain in critical care patients

Utilizing multimodal analgesic regimens combining opioids, non-opioids,

regional anesthesia techniques, and adjunctive medications can optimize pain
control while minimizing opioid-related adverse effects and promoting early
mobilization and rehabilitation (Devlin et al., 2008).

More points to be added

Conclusion
More points to be added

References
More points to be added