{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:25:55Z","timestamp":1792790755514,"version":"4.5.0"},"reference-count":84,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T00:00:00Z","timestamp":1672790400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Intensive Care Med"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:p>Rib fractures are present in 15% of all traumas and 60% of patients with chest traumas. Rib fractures are not life-threatening in isolation, but they can be quite painful which leads to splinting and compromise of respiratory function. Splinting limits the ability of a patient to take a deep breath, which leads to atelectasis, atelectasis to poor secretion removal, and poor secretion removal leads to pneumonia. Pneumonia is the common pathway to respiratory failure in patients with rib fractures. It is noted that in the elderly, each rib fracture increases developing pneumonia by 27% and the risk of dying by 19%. From a public health perspective, rib fractures have long-term implications with only 59% of patients returning to work at 6 months. In this review we will examine the state of art as it currently exists with regard to the management of pain associated with rib fractures. Included in this overview will be a brief review of the anatomy of the thorax and some important physiologic concepts, the latest trends in pharmacologic and noninvasive means of managing rib pain, a special section on epidural anesthesia, some other alternative invasive methods of pain control, and a review of the recent literature on rib plating. Finally, a practical, easy to follow guideline, to manage the patient with pain from rib fractures will be presented.<\/jats:p>","DOI":"10.1177\/08850666221148644","type":"journal-article","created":{"date-parts":[[2023,1,5]],"date-time":"2023-01-05T01:39:57Z","timestamp":1672882797000},"page":"327-339","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":24,"title":["Comprehensive Review of Current Pain Management in Rib Fractures With Practical Guidelines for Clinicians"],"prefix":"10.1177","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3423-9488","authenticated-orcid":false,"given":"Frederick B.","family":"Rogers","sequence":"first","affiliation":[{"name":"Regions Hospital, St. Paul, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8836-8891","authenticated-orcid":false,"given":"Nicholas J.","family":"Larson","sequence":"additional","affiliation":[{"name":"Regions Hospital, St. Paul, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2349-6593","authenticated-orcid":false,"given":"Abigail","family":"Rhone","sequence":"additional","affiliation":[{"name":"Regions Hospital, St. Paul, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2468-0939","authenticated-orcid":false,"given":"Dalila","family":"Amaya","sequence":"additional","affiliation":[{"name":"Regions Hospital, St. Paul, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3100-0938","authenticated-orcid":false,"given":"Barbara A.","family":"Olson-Bullis","sequence":"additional","affiliation":[{"name":"Regions Hospital, St. Paul, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0400-1153","authenticated-orcid":false,"given":"Beno\u00eet X.","family":"Blondeau","sequence":"additional","affiliation":[{"name":"Regions Hospital, St. Paul, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,1,4]]},"reference":[{"key":"bibr1-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002559"},{"key":"bibr2-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2016.11.026"},{"key":"bibr3-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1097\/01.ta.0000223463.88422.6a"},{"key":"bibr4-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000744"},{"key":"bibr5-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000001954"},{"key":"bibr6-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002795"},{"key":"bibr7-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1177\/0003134820956276"},{"key":"bibr8-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-019-3943-x"},{"key":"bibr9-08850666221148644","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp140157"},{"key":"bibr10-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2019.09.032"},{"issue":"3","key":"bibr11-08850666221148644","first-page":"99","volume":"3","author":"Esmailian M","year":"2015","journal-title":"Emerg(Tehran)"},{"key":"bibr12-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1177\/0003134820940268"},{"key":"bibr13-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2018.06.002"},{"key":"bibr14-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002875"},{"key":"bibr15-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002479"},{"key":"bibr16-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1177\/00031348211050838"},{"key":"bibr17-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1177\/0003134820945224"},{"key":"bibr18-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2009.10.020"},{"key":"bibr19-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1159\/000441002"},{"key":"bibr20-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1177\/000313481107700419"},{"key":"bibr21-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(75)90044-5"},{"key":"bibr22-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1093\/ajhp\/59.22.2215"},{"key":"bibr23-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivac158"},{"key":"bibr24-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pny224"},{"issue":"3","key":"bibr25-08850666221148644","first-page":"87","volume":"3","author":"Hashemzadeh S","year":"2011","journal-title":"J Cardiovasc Thorac Res"},{"key":"bibr26-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-018-0918-7"},{"key":"bibr27-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2004.05.019"},{"key":"bibr28-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/j.egja.2015.06.001"},{"key":"bibr29-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2005.07.022"},{"key":"bibr30-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3182ab1b08"},{"issue":"4837591","key":"bibr31-08850666221148644","first-page":"1","volume":"2019","author":"Peek J","year":"2019","journal-title":"Crit Care Res Pract."},{"key":"bibr32-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002113"},{"key":"bibr33-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2017.02.057"},{"key":"bibr34-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2004.11.022"},{"key":"bibr35-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/j.acpain.2007.10.019"},{"key":"bibr36-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-8537(05)70172-3"},{"key":"bibr37-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000451"},{"issue":"3","key":"bibr38-08850666221148644","first-page":"289","volume":"23","author":"Barrios A","year":"2020","journal-title":"Pain Physician"},{"key":"bibr39-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1177\/00031348221091956"},{"key":"bibr40-08850666221148644","author":"Syal R","journal-title":"Braz J Anesthesiol (English Edition)"},{"key":"bibr41-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pnab214"},{"key":"bibr42-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2021.01.020"},{"key":"bibr43-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1177\/0300060517710068"},{"key":"bibr44-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e318166d76d"},{"key":"bibr45-08850666221148644","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5049.123327"},{"key":"bibr46-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1111\/anae.12344"},{"key":"bibr47-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1111\/1742-6723.13724"},{"key":"bibr48-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2020.12.041"},{"key":"bibr49-08850666221148644","doi-asserted-by":"publisher","DOI":"10.2147\/LRA.S207791"},{"key":"bibr50-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco-2020-000621"},{"issue":"1","key":"bibr51-08850666221148644","first-page":"e21322","volume":"14","author":"Nair A","year":"2022","journal-title":"Cureus"},{"issue":"3","key":"bibr52-08850666221148644","doi-asserted-by":"crossref","first-page":"e10525","DOI":"10.1002\/aet2.10525","volume":"5","author":"Rider AC","year":"2020","journal-title":"AEM Educ Train"},{"key":"bibr53-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1002\/jum.15953"},{"key":"bibr54-08850666221148644","doi-asserted-by":"publisher","DOI":"10.2147\/JPR.S198350"},{"key":"bibr55-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2019.12.044"},{"key":"bibr56-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31823c96e0"},{"key":"bibr57-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-200109000-00019"},{"key":"bibr58-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3182895bb0"},{"key":"bibr59-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2012.12.024"},{"key":"bibr60-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000001350"},{"key":"bibr61-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000003140"},{"key":"bibr62-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1510\/icvts.2005.111807"},{"key":"bibr63-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-200204000-00020"},{"key":"bibr64-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2022.002"},{"key":"bibr65-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2012.10.010"},{"key":"bibr66-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002559"},{"issue":"11","key":"bibr67-08850666221148644","doi-asserted-by":"crossref","first-page":"e224299","DOI":"10.1001\/jamasurg.2022.4299","volume":"157","author":"Dehghan N","year":"2022","journal-title":"JAMA Surg."},{"key":"bibr68-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-019-0258-x"},{"key":"bibr69-08850666221148644","unstructured":"Randomized Control Trial, Cryoablation as an Adjunct to Surgical Stabilization of Rib Fractures. ClinicalTrials.gov identifier: NCT05415384."},{"key":"bibr70-08850666221148644","unstructured":"Surgical Stabilization for Rib Fractures. ClinicalTrials.gov identifier: NCT04081233."},{"key":"bibr71-08850666221148644","unstructured":"Meyer DE. The Effect of Early Stabilization of Rib Fractures on Patient-Centered Outcomes: A Randomized Clinical Trial. Surgical Stabilization for Rib Fractures\u2014Full Text View\u2014ClinicalTrials.gov. https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04081233. Accessed October 17, 2022."},{"key":"bibr72-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.1316"},{"key":"bibr73-08850666221148644","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc2001.10.5.320"},{"key":"bibr74-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2012.05.015"},{"key":"bibr75-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000867"},{"key":"bibr76-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2018.03.025"},{"key":"bibr77-08850666221148644","volume-title":"PIC score: PIC Score: An innovative approach to improve outcome from chest wall injury at a level 1 trauma center","author":"Terry SM","year":"2015"},{"key":"bibr78-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2022.04.001"},{"key":"bibr79-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-1114"},{"key":"bibr80-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000001209"},{"key":"bibr81-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1097\/ACO.0000000000000637"},{"key":"bibr82-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000925"},{"key":"bibr83-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/j.thorsurg.2017.01.004"},{"key":"bibr84-08850666221148644","doi-asserted-by":"publisher","DOI":"10.1016\/j.tcr.2015.10.001"}],"container-title":["Journal of Intensive Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08850666221148644","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08850666221148644","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08850666221148644","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T22:57:29Z","timestamp":1777503449000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08850666221148644"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,4]]},"references-count":84,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,4]]}},"alternative-id":["10.1177\/08850666221148644"],"URL":"https:\/\/doi.org\/10.1177\/08850666221148644","relation":{},"ISSN":["0885-0666","1525-1489"],"issn-type":[{"value":"0885-0666","type":"print"},{"value":"1525-1489","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,4]]}}}