Inflammation and Pain in Neurocritical Care: New Insights from Recent Research

A recent study found that early systemic inflammatory markers did not predict ICU pain burden after aneurysmal subarachnoid hemorrhage (SAH); instead, younger age and chronic opioid use tracked with higher pain during the ICU stay.

That result challenges the expectation that a single early peripheral inflammatory panel can reliably triage analgesic needs in the immediate ED-to-ICU interval and reframes how clinicians should view early biomarker-based risk stratification.

In a retrospective multicenter cohort, investigators abstracted early inflammatory blood markers and serial pain scores from the electronic health record. Participants (N=523; mean age 55 years, 67% female; median Hunt–Hess 3; modified Fisher score 3–4 in 89%) were divided into quartiles by average daily pain burden for analysis. The team used univariate testing and ordinal logistic regression and ran a sensitivity analysis limited to patients able to verbally report pain in the ICU.

Statistically, early blood inflammatory biomarkers showed no association with higher ICU pain burden in univariate or multivariable models, a finding that held in the verbally reportable subgroup. By contrast, the cohort demonstrated an age effect (older age correlated with lower ICU pain burden per the authors’ estimated metric) and an association between chronic opioid use and higher pain burden (reported odds ratio 0.59, 95% CI 0.38–0.90 in the manuscript’s model output); the authors report these associations as robust to sensitivity testing. Overall, inflammatory markers did not predict a persistently high pain trajectory as hypothesized.

Clinically, these data argue for prioritizing bedside risk assessment and patient phenotype when anticipating ICU pain intensity after SAH—not relying on a single early peripheral inflammatory panel. In practice, that means prompt, targeted pain evaluation and multimodal planning for patients identified by age and opioid-history profiles rather than early biomarker signals alone.