Despite the fact that various pharmacologic factors may alter protein binding, volume status and function of end-organ, specifically in elderly people, the pain management is somehow underestimated and could not be paid a reasonable attention by healthcare providers(16,17). Trauma, sepsis, hipoxemia and some drugs can decrease the hepatic blood flow and drug which make the situation complex in turn for a physician when the pain exist. Pain in critically ill patients remains undertreated even though the decades of studies, guidelines and educational efforts have been introduced into the literature. Because of the inappropriate pain management in ICU, a range of complications including the prolonged mechanical ventilation, increased length of the stay, hypoxemia, thromboembolic events, pain-related immune supression, delirium and chronic pain etc. increases in number and severity(17,18,19). It is recommended that a therapeutic trial of an analgesic should be considered in patients when the unpredicted and abnormal changes happen in clinic such as increased blood pressure, tachycardia, agitation or delirium etc(17,20). Because the pain causes sympathetic stimulation it is often detectable by the symptoms such as tachycardia and increased blood pressure. But it should be bear in mind that excessive or prolonged sedation can also cause compression ulcers, nerve compression or delirium etc (21).
Despite the high prevalance of the pain, it is often underreported in older people and perceived as something inevitable to feel and should be tolerated during aging process, but the evidence shows that it is higly possible to be a result of pathology involving a physical or psychological process (22,23). Furthermore, it was shown in several studies that the most of the patients that were under mechanical ventilation received sedatives and analgesics without further evaluation in detail(24,25). With the present study, we revealed that even though the most of patients in ICU was elderly (68.8%) and the percentage of patients that analgesics were administered was low at 39.2%. The most commonly used analgesics for all patients admitted to the ICU were pethidine (26.1%) in another study whereas it was the tradamol (15.2%) in our study (26). When we compare the usage of analgesics between genders, the women were administered analgesics with a higher proportion than men (p<0.05). In many studies, the effect of gender on pain was shown that women need more analgesics than men as the same in presented study(27,28,29). We found that in ICU the percentage of analgesics that used as single was 29.3%, which is not an effective way to alleviate the pain, especially in geriatric patients. So not only pharmacotherapy with single or combined type, but also music therapy or hand massage therapy were proven to be effective to some extent on pain relief alone or with analgesics (30,31,32,33). In sum, the pain management needs a multidisciplinary approach and educational studies that can improve the attitudes and behaviours of the healthcare workers.
Limitations: Pain is a symptom due to many reasons that is hard to associated with all of them in a study. It is difficult to state a relationship between the observed predictors and psychological side of pain in this study. Another limitation of this study was that the variables related to the patients were not asked. Furthermore, the diagnostic evaluation of the psychiatric conditions of the individuals (such as previous psychotropic medications, etc.) was not performed. These dimensions should be considered in future studies.