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Background <p>Chronic pain management in critically ill patients poses significant challenges due to complex pain mechanisms and physiological&#xa0;instability. Traditional opioid-based regimens, although effective, are often associated with adverse effects such as respiratory&#xa0;depression, delirium, and dependence.</p> Objective <p>To explore the pathophysiology of chronic pain in critically ill patients and evaluate the role of multimodal pain management (MPM) in&#xa0;improving analgesic outcomes while minimizing opioid use.</p> Methods <p>This narrative review examines the underlying mechanisms of chronic pain in critical illness, including nociceptive, neuropathic, and inflammatory pathways. It evaluates pharmacologic and non-pharmacologic components of MPM, as well as interventional techniques and ethical considerations in critical care settings.</p> Results <p>MPM strategies incorporate opioid-sparing pharmacologic agents such as nonsteroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, and regional anesthesia. Non-pharmacologic interventions, including physical therapy, cognitive-behavioral therapy, acupuncture, and transcutaneous electrical nerve stimulation, contribute to effective pain control. Interventional procedures like epidural analgesia and nerve blocks further enhance analgesic outcomes. MPM is associated with improved pain relief, reduced opioid dependency, and better overall patient outcomes.</p> Conclusion <p>Multimodal pain management offers a promising, evidence-based approach to chronic pain in critically ill patients. By balancing effective analgesia with minimized opioid use and reduced adverse effects, MPM can improve quality of care. Ethical considerations such as over-sedation and drug interactions must guide its careful implementation in critical care environments.</p>

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Optimizing Multimodal Analgesia in Critical Care and Surgical Settings: Applications and Considerations

  • 期刊论文

  • 发表日期：

    2025年8月6日

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  • Pranav K. Sharma,
  • Devendra Tripathi,
  • Aashwin Kaushal,
  • Sachin M. Chaudhary,
  • Natasha Choudhary,
  • Tareq M. Saleh,
  • Chinthala Swetha,
  • Manju Rai

摘要

Background

Chronic pain management in critically ill patients poses significant challenges due to complex pain mechanisms and physiological instability. Traditional opioid-based regimens, although effective, are often associated with adverse effects such as respiratory depression, delirium, and dependence.

Objective

To explore the pathophysiology of chronic pain in critically ill patients and evaluate the role of multimodal pain management (MPM) in improving analgesic outcomes while minimizing opioid use.

Methods

This narrative review examines the underlying mechanisms of chronic pain in critical illness, including nociceptive, neuropathic, and inflammatory pathways. It evaluates pharmacologic and non-pharmacologic components of MPM, as well as interventional techniques and ethical considerations in critical care settings.

Results

MPM strategies incorporate opioid-sparing pharmacologic agents such as nonsteroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, and regional anesthesia. Non-pharmacologic interventions, including physical therapy, cognitive-behavioral therapy, acupuncture, and transcutaneous electrical nerve stimulation, contribute to effective pain control. Interventional procedures like epidural analgesia and nerve blocks further enhance analgesic outcomes. MPM is associated with improved pain relief, reduced opioid dependency, and better overall patient outcomes.

Conclusion

Multimodal pain management offers a promising, evidence-based approach to chronic pain in critically ill patients. By balancing effective analgesia with minimized opioid use and reduced adverse effects, MPM can improve quality of care. Ethical considerations such as over-sedation and drug interactions must guide its careful implementation in critical care environments.