{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T07:32:47Z","timestamp":1774078367038,"version":"3.50.1"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2014,1,1]],"date-time":"2014-01-01T00:00:00Z","timestamp":1388534400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Intensive 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess self-reported procedural pain intensity versus baseline pain, examine pain intensity differences across procedures, and identify risk factors for procedural pain intensity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prospective, 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Pain intensity on a 0\u201310 numeric rating scale increased significantly from baseline pain during all procedures (P &amp;lt; 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\u20137), 4.5 (2\u20137), and 4 (2\u20136), 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Knowledge of risk factors for greater procedural pain intensity identified in this study may help clinicians select interventions that are needed to minimize procedural pain.<\/jats:p>\n                    <jats:p>Clinical trial registered with www.clinicaltrials.gov (NCT 01070082).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.201306-1174oc","type":"journal-article","created":{"date-parts":[[2013,11,21]],"date-time":"2013-11-21T17:11:43Z","timestamp":1385053903000},"page":"39-47","source":"Crossref","is-referenced-by-count":304,"title":["Determinants of Procedural Pain Intensity in the Intensive Care Unit. The Europain\u00ae Study"],"prefix":"10.1093","volume":"189","author":[{"given":"Kathleen A.","family":"Puntillo","sequence":"first","affiliation":[{"name":"Department of Physiological Nursing, University of California, San Francisco, San Francisco, California"}]},{"given":"Adeline","family":"Max","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, University of Paris-Diderot, Saint Louis Hospital, Paris, France"}]},{"given":"Jean-Francois","family":"Timsit","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, H\u00f4pital A. Michallon, Grenoble, France"}]},{"given":"Lucile","family":"Vignoud","sequence":"additional","affiliation":[{"name":"Institut Albert Bonniot, INSERM U823, Grenoble, France"}]},{"given":"Gerald","family":"Chanques","sequence":"additional","affiliation":[{"name":"D\u00e9partement d'Anesth\u00e9sie-R\u00e9animation, H\u00f4pital Saint Eloi, France"},{"name":"Unit\u00e9 U1046 de l\u2019Institut National de la Sant\u00e9 et de la Recherche, University of Montpellier, Montpellier, France"}]},{"given":"Gemma","family":"Robleda","sequence":"additional","affiliation":[{"name":"Servei de Medicina Intensiva, Hospital de Sant Pau, Barcelona, Spain"}]},{"given":"Ferran","family":"Roche-Campo","sequence":"additional","affiliation":[{"name":"Servei de Medicina Intensiva, Hospital de Sant Pau, Barcelona, Spain"}]},{"given":"Jordi","family":"Mancebo","sequence":"additional","affiliation":[{"name":"Servei de Medicina Intensiva, Hospital de Sant Pau, Barcelona, Spain"}]},{"given":"Jigeeshu V.","family":"Divatia","sequence":"additional","affiliation":[{"name":"Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Mumbai, India"}]},{"given":"Marcio","family":"Soares","sequence":"additional","affiliation":[{"name":"D'Or Institute for Research Education, Postgraduate Program, Instituto Nacional de C\u00e2ncer, Rio de Janeiro, Brazil"}]},{"given":"Daniela C.","family":"Ionescu","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care I, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania"}]},{"given":"Ioana M.","family":"Grintescu","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care Department, Clinical Emergency Hospital, Bucharest, Romania"}]},{"given":"Irena L.","family":"Vasiliu","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care Department, Clinical Emergency Hospital, Bucharest, Romania"}]},{"given":"Salvatore Maurizio","family":"Maggiore","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Policlinico A. Gemelli, Universit\u00e0 Cattolica del Sacro Cuore, Rome, Italy"}]},{"given":"Katerina","family":"Rusinova","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, General University Hospital, First Faculty of Medicine of Charles University, Prague, Czech Republic"}]},{"given":"Radoslaw","family":"Owczuk","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Gdansk, Poland"}]},{"given":"Ingrid","family":"Egerod","sequence":"additional","affiliation":[{"name":"Trauma Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark"}]},{"given":"Elizabeth D. E.","family":"Papathanassoglou","sequence":"additional","affiliation":[{"name":"Department of Nursing, Cyprus University of Technology, Nicosia, Cyprus"}]},{"given":"Maria","family":"Kyranou","sequence":"additional","affiliation":[{"name":"Nursing Department, Papageorgiou Hospital, Thessaloniki, Greece"}]},{"given":"Gavin M.","family":"Joynt","sequence":"additional","affiliation":[{"name":"The Chinese University of Hong Kong, Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Shatin, Hong Kong"}]},{"given":"Gast\u00f3n","family":"Burghi","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Hospital Maciel, Santorio Americano and Sanatorio Hospital in Montevideo, Montevideo, Uruguay"}]},{"given":"Ross C.","family":"Freebairn","sequence":"additional","affiliation":[{"name":"Intensive Care Services, Hawke's Bay Hospital, Hastings, New Zealand"}]},{"given":"Kwok M.","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine and School of Population Health, Royal Perth Hospital and University of Western Australia, Perth, Australia"}]},{"given":"Anne","family":"Kaarlola","sequence":"additional","affiliation":[{"name":"Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland"}]},{"given":"Rik T.","family":"Gerritsen","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Medical Centre Leeuwarden, Netherlands"}]},{"given":"Jozef","family":"Kesecioglu","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Medical Center, Utrecht, Netherlands"}]},{"given":"Miroslav M. S.","family":"Sulaj","sequence":"additional","affiliation":[{"name":"Clinic of Anesthesiology and Intensive Medicine, Jessenius Faculty of Medicine in Martin-Comenius University in Bratislava, University Hospital Martin, Martin, Slovakia"}]},{"given":"Michelle","family":"Norrenberg","sequence":"additional","affiliation":[{"name":"Intensive Care Unit Department, Erasme Hospital, Belgium"}]},{"given":"Dominique D.","family":"Benoit","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Erasme University Hospital, Universit\u00e9 Libre de Bruxelles, Brussels, Belgium"}]},{"given":"Myriam S. 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