Pain management in neurocritical care; An update

Athir Morad, Salia Farrokh, Alexander Papangelou

Research output: Contribution to journalReview article

Abstract

Purpose of review Pain management in neurocritical care is a subject often avoided because of concerns over the side-effects of analgesics and the potential to cause additional neurological injury with treatment. The sedation and hypercapnia caused by opioids have been feared to mask the neurological examination and contribute to elevations in intracranial pressure. Nevertheless, increasing attention to patient satisfaction has sparked a resurgence in pain management. As opioids have remained at the core of analgesic therapy, the increasing attention to pain has contributed to a growing epidemic of opioid dependence. In this review, we summarize the most recent literature regarding opioids and their alternatives in the treatment of acute pain in patients receiving neurocritical care. Recent findings Studies on pain management in neurocritical care continue to explore nonopioid analgesics as part of a multimodal strategy aimed at decreasing overall opioid consumption. Agents including local anesthetics, acetaminophen, ketamine, gabapentinoids, and dexmedetomidine continue to demonstrate efficacy. In addition, the prolonged longitudinal course of many recent trials has also revealed more about the transition from acute to chronic pain following hospitalization. Summary In an era of increasing attention to patient satisfaction mitigated by growing concerns over the harms imposed by opioids, alternative analgesic therapies are being investigated with promising results.

Original languageEnglish (US)
Pages (from-to)72-79
Number of pages8
JournalCurrent Opinion in Critical Care
Volume24
Issue number2
DOIs
StatePublished - Apr 1 2018

Keywords

  • acute pain
  • craniotomy
  • neurocritical care
  • opioid safety
  • spine surgery
  • subarachnoid hemorrhage

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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