Management of Pain in the Intensive Care Unit: A Nordic Survey

Background: Pain is common in intensive care unit (ICU) patients with up to one-third experiencing pain at rest and even more during mobilization and clinical procedures. This survey aimed to explore physicians' attitudes and preferences regarding pain management in adult ICU patients in the Nordic countries. Methods: We conducted an electronic survey targeting physicians working regularly in an ICU in the Nordic countries: Denmark, Finland, Iceland, Norway and Sweden. The survey focused on pain assessment, pharmacological treatments, and post-discharge follow-up of adult ICU patients. Results: The survey was distributed to 606 physicians, and 360 responses were received (overall response rate 59%). Respondents were primarily from Denmark, with only a few respondents from the remaining Nordic countries. Most respondents were specialists in anesthesiology working in mixed ICUs in public specialist hospitals. Standardized pain assessment tools were widely used in non-sedated patients, while only half of respondents employed standardized pain assessment tools in sedated patients. Respondents reported that pain was assessed multiple times daily in both non-sedated and sedated patients. Daily wake-up calls in sedated patients were considered important by almost all respondents. Morphine was the preferred opioid for oral- and intravenous bolus administration, while remifentanil was preferred for intravenous continuous administration. However, preferences varied across countries with regard to both opioid- and non-opioid analgesics. Nearly half of respondents expressed concerns regarding the development of opioid-induced hyperalgesia. Methadone was the most frequently preferred drug for opioid weaning, although preferences varied between countries. Most respondents acknowledged the importance of ICU-follow up programs, but only about half of respondents reported that their ICU currently offered a follow-up service. Conclusion: This Nordic survey explored ICU physicians' attitudes and preferences regarding pain management in adult ICU patients. Respondents reported assessing pain frequently, employing standardized pain assessment tools primarily in non-sedated patients. Daily wake-up calls in sedated patients were generally perceived as important. Interestingly, preferences regarding opioid- and non-opioid analgesics varied between Nordic countries. ICU-follow up programs were recognized as important but were not consistently implemented. Despite a high overall response rate, the generalizability of our findings is impaired by limited participation in most Nordic countries except Denmark. Editorial Comment: This survey describes the physician perspective on predominantly pharmacological pain management in selected ICUs within the Nordic countries.