Evidence map›Paper›PMID 39841212›Full record

SynthesisIntensive care medicine2025

The association between pain, analgesia, and delirium among critically ill adults: a systematic review and meta-analysis.

Amanda Y Leong, Stefan Edginton, Laurie A Lee, Natalia Jaworska, Lisa Burry, Kirsten M Fiest, Christopher J Doig, Daniel J Niven

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Intensive care medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Review
  4. Review
  5. Review
  6. Article
  7. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Amanda Y LeongDepartment of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.ORCID 0000-0002-2593-7911
Stefan EdgintonDepartment of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.ORCID 0000-0001-6243-4259
Laurie A LeeFaculty of Nursing, University of Calgary, Calgary, Canada.ORCID 0000-0002-0008-393X
Natalia JaworskaDepartment of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.ORCID 0000-0002-2995-5527
Lisa BurryDepartment of Pharmacy, Leslie Dan Faculty of Pharmacy, and Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health, University of Toronto, , Toronto, Canada.ORCID 0000-0002-6545-3890
Kirsten M FiestDepartment of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Christopher J DoigDepartment of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Daniel J NivenDepartment of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada. Daniel.niven@albertahealthservices.ca.ORCID 0000-0002-9527-0577

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeWe performed a systematic review with meta-analysis examining the relationship between pain or pain medications and delirium occurence, duration, and severity.

methodsWe searched MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials from inception to May 15, 2023. We included randomised or observational studies among critically ill adults, that reported data on pain or exposure to analgesics, and reported delirium presence, duration, or severity with no language or region restrictions. PROSPERO ID: CRD42022367715. Two authors independently screened records and extracted data. Risk of bias was evaluated using Risk of Bias 2 or the Risk of Bias In Non-randomized Studies of Interventions. We pooled data using the Hartung-Knapp Sidik-Jonkmann random effects model. PRISMA was followed.

resultsFrom 8,054 citations, 90 studies (119,230 patients) published between 2001 and 2023 were included in the systematic review. 41 studies were included in the primary meta-analysis examining prevalent delirium: seven studies evaluated pain; 12 studies evaluated fentanyl; and five studies evaluated morphine. There was a trend to association between pain and delirium occurrence (OR 2.49, 95% CI 0.98-6.30), and a significant association between pain and incident delirium (OR 3.70, 95% CI 1.73-7.93). Fentanyl (OR 2.49, 95% CI 1.45-4.27) and morphine (OR 2.13, 95% CI 1.21-3.75) were associated with delirium occurrence. Risk of bias was critical for many studies.

conclusionsWe observed an association between pain and incident delirium among critically ill adults. Exposure to morphine or fentanyl (but no other pain medications) was associated with increased risk of delirium occurrence.

Indexed as

AnalgesiaAnalgesicsCritical IllnessDeliriumPainPain ManagementAdultHumansAnalgesicsAnalgesicsCritical careDeliriumPainPain measurement

Identifiers

PMID39841212

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.