ArticleAmerican journal of respiratory and critical care medicine2014
Determinants of procedural pain intensity in the intensive care unit. The Europain® study.
Article in American journal of respiratory and critical care medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 100 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Adjuvant Continuous Infusion of Nefopam Versus Standard of Care in Mechanically Ventilated Critically Ill Patients: Randomized Double-blind Controlled Study
Prevention of Infection of the Respiratory Tract by Applying Methods That Are Non-Invasive for Extraction of Secretions. An Open Label, Randomized, Assessor-blinded Trial.
Evaluation of the Effectiveness of Training in Basic and Assisted Communication Techniques for Intensive Care Nurses: A Quasi-experimental Study
Who cites it
100 citing papers in PubMed, 3 syntheses or guidelines pooled it, 360 citations in OpenAlex.
- The effects of virtual reality on pain relief in ICU patients: meta-analysis and systematic review.Frontiers in medicine · 2026Pooled it
- Comparison between remifentanil and other opioids in adult critically ill patients: A systematic review and meta-analysis.Medicine · 2021Pooled it
- Comparison of two behavioural pain scales for the assessment of procedural pain: A systematic review.Nursing open · 2021Pooled it
- Depressive symptoms are a key determinant of health-related quality of life in ICU survivors with psychological distress.Scientific reports · 2026Trial
- Protocol for a multicenter, randomized, single-blind, non-inferiority trial comparing nalbuphine hydrochloride versus hydromorphone hydrochloride for analgesia in mechanically ventilated ICU patients.Frontiers in pharmacology · 2026Trial
- Nociception level index monitoring in intensive care: pain awareness in pressure ulcer care in unconscious patients: a randomized controlled pilot study.Irish journal of medical science · 2025Trial
- Hypnosis for unplanned procedural pain in the intensive care unit: the HYPIC randomized clinical trial.Critical care (London, England) · 2025Trial
- Pain monitoring in intensive care: How does the nociception level index affect treatment and prognosis? A randomized, controlled, double-blind trial.Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES · 2024Trial
- Dyspnea is severe and associated with a higher intubation rate in de novo acute hypoxemic respiratory failure.Critical care (London, England) · 2024Trial
- Comparison of Mechanical Insufflation-Exsufflation and Hypertonic Saline and Hyaluronic Acid With Conventional Open Catheter Suctioning in Intubated Patients.Respiratory care · 2024Trial
- Effects of virtual reality on chest tube removal pain management in patients undergoing coronary artery bypass grafting: a randomized clinical trial.Scientific reports · 2024Trial
- Intranasal Fentanyl for Intervention-Associated Breakthrough Pain After Cardiac Surgery.Clinical pharmacokinetics · 2021Trial
- Impact of audit and feedback with action implementation toolbox on improving ICU pain management: cluster-randomised controlled trial.BMJ quality & safety · 2019Trial
- Trial
- Trial
- Fentanyl as pre-emptive treatment of pain associated with turning mechanically ventilated patients: a randomized controlled feasibility study.Intensive care medicine · 2016Trial
- Automatic pain assessment from facial action units in ICU patients via various machine learning models.Scientific reports · 2026Article
- Practice of airway clearance in critically ill patients: a cross-sectional survey of respiratory therapists and physiotherapists in China.Journal of thoracic disease · 2026Article
- Association Between Nursing Diagnoses and Mortality in Patients with Cardiac Disease: A Retrospective Cohort Study.Clinics and practice · 2026Article
- Strategies for a Rational Use of Opioids in Critical Care Settings.Journal of clinical medicine · 2026Review
40 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
38 authors at 20 institutions in 27 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
rationaleIntensive care unit (ICU) patients undergo several diagnostic and therapeutic procedures every day. The prevalence, intensity, and risk factors of pain related to these procedures are not well known.
objectivesTo assess self-reported procedural pain intensity versus baseline pain, examine pain intensity differences across procedures, and identify risk factors for procedural pain intensity.
methodsProspective, cross-sectional, multicenter, multinational study of pain intensity associated with 12 procedures. Data were obtained from 3,851 patients who underwent 4,812 procedures in 192 ICUs in 28 countries. MEASUREMENTS AND MAIN
resultsPain intensity on a 0-10 numeric rating scale increased significantly from baseline pain during all procedures (P < 0.001). Chest tube removal, wound drain removal, and arterial line insertion were the three most painful procedures, with median pain scores of 5 (3-7), 4.5 (2-7), and 4 (2-6), respectively. By multivariate analysis, risk factors independently associated with greater procedural pain intensity were the specific procedure; opioid administration specifically for the procedure; preprocedural pain intensity; preprocedural pain distress; intensity of the worst pain on the same day, before the procedure; and procedure not performed by a nurse. A significant ICU effect was observed, with no visible effect of country because of its absorption by the ICU effect. Some of the risk factors became nonsignificant when each procedure was examined separately.
conclusionsKnowledge of risk factors for greater procedural pain intensity identified in this study may help clinicians select interventions that are needed to minimize procedural pain. Clinical trial registered with www.clinicaltrials.gov (NCT 01070082).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.