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Management of Chronic Pain in the Intensive Care Unit 

Management of Chronic Pain in the Intensive Care Unit
Chapter:
Management of Chronic Pain in the Intensive Care Unit
Author(s):

Pavan Tankha

and Marisa Lomanto

DOI:
10.1093/med/9780199349302.003.0009
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date: 18 October 2019

This chapter describes strategies for management of acute on chronic pain in the intensive care unit setting. Hospitalized patients with acute or chronic decompensation of vital organ systems, such as liver or renal failure, admitted to the intensive care unit present a challenge for the clinician, as a third to almost half of these patients will have pre-existing chronic pain conditions they are being treated for. Abrupt discontinuation of chronic opiates or adjuvant medications may precipitate symptoms of withdrawal. Critically ill patients have altered physiological status and pharmacokinetic changes. When these are combined with pre-existing pain medications, patients risk altered mental status, worsening of their clinical condition, or even respiratory failure and death. If clinically indicated, resuming home pain medications is warranted prior to transfer to the regular care floor.

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