PERSONALISED PAIN TREATMENT IN INTENSIVE CARE UNITS - MONITORING OF NOCICEPTION.

The personalization of pain treatment in intensive care units was developed due to the interindividual variability and heterogeneity of critically ill patients. A personalized approach to pain is based on the prediction and continuous assessment of pain. In critically ill patients, this approach includes the knowledge of the underlying cause of pain related to the primary diagnosis, the causes of procedural pain and previous chronic pain conditions of the patient, in order to apply a specific therapeutic approach. Available treatment recommendations emphasize the use of adaptive or dynamic analgesia, with titration of analgesics according to changes in the clinical state of patients. They indicate the necessity of pain assessment with tools for pain intensity assessment and therapy evaluation, as well as the need for assessment at regular time intervals. Despite treatment guidelines, clinical practice shows significant deviations from evidence-based recommendations. The reasons are primarily the non-recognition of pain, insufficient knowledge of analgesics (type and dose), lack of regular assessment and inadequacy of the applied tools for pain assessment. In terms of personalization, there is a need to develop objective pain assessment methods, such as sensitive and pain-specific tools that do not rely on the patient's ability to communicate and are independent of assessors, disease characteristics and pharmacological interventions in critically ill patients.