Beyond Pain: An Exploratory Secondary Analysis of Psychological and Physical Discomfort Domains in  ICU Patients

BACKGROUND: Despite growing recognition that ICU discomfort extends beyond pain, no study has empirically compared the proportion and interrelationships of psychological discomfort, physical discomfort and pain using clinically meaningful thresholds. AIM: The aim of this study was to examine the relationships between psychological discomfort, physical discomfort and pain based on patients' recalled discomfort reported within 24 h after ICU discharge. STUDY DESIGN: Patients completed the Inconforts des Patients de REAnimation (IPREA) questionnaire, a general discomfort visual analogue scale (VAS) and a general pain VAS (0-100 mm) anchored by 'no pain' and 'worst imaginable pain' within 24 h after ICU discharge from surgical, medical and cardiac ICUs of a tertiary hospital. A secondary analysis was conducted on the data, and IPREA items were grouped into three domains: psychological discomfort, physical discomfort without pain and pain. Descriptive and inferential statistics examined relationships between the three domains. The proportion of scores at the moderate threshold (40-69/100) and at or above the severe threshold (≥ 70/100) for pain, psychological and physical discomfort was determined. RESULTS: (2) = 16.84, p < 0.001); after Bonferroni correction, psychological discomfort versus pain remained significant. CONCLUSIONS: Discomfort in ICU patients extends beyond pain, underscoring the need for multidimensional nursing assessment. RELEVANCE TO CLINICAL PRACTICE: Routine multidimensional assessment of discomfort can improve patient-centered ICU care and prevent misinterpretation of non-pain discomfort as pain. These findings reinforce the importance of incorporating psychological and physical discomfort assessments into daily ICU practice.