Comparison of Self-Reported and Behavioral Pain Assessment Tools in Critically Ill Patients

2018 ◽  
Vol 35 (5) ◽  
pp. 453-460 ◽  
Author(s):  
Rima H. Bouajram ◽  
Christian M. Sebat ◽  
Dawn Love ◽  
Erin L. Louie ◽  
Machelle D. Wilson ◽  
...  
Keyword(s):  
Critically Ill ◽  
Pain Assessment ◽  
Critically Ill Patients ◽  
Strong Correlation ◽  
Rating Scale ◽  
Assessment Method ◽  
Pain Scale ◽  
Assessment Tools ◽  
Pain Scales ◽  
Behavioral Pain Scale

Background:Self-reported and behavioral pain assessment scales are often used interchangeably in critically ill patients due to fluctuations in mental status. The correlation between scales is not well elucidated. The purpose of this study was to describe the correlation between self-reported and behavioral pain scores in critically ill patients.Methods:Pain was assessed using behavioral and self-reported pain assessment tools. Behavioral pain tools included Critical Care Pain Observation Tool (CPOT) and Behavioral Pain Scale (BPS). Self-reported pain tools included Numeric Rating Scale (NRS) and Wong-Baker Faces Pain Scales. Delirium was assessed using the confusion assessment method for the intensive care unit. Patient preference regarding pain assessment method was queried. Correlation between scores was evaluated.Results:A total of 115 patients were included: 67 patients were nondelirious and 48 patients were delirious. The overall correlation between self-reported (NRS) and behavioral (CPOT) pain scales was poor (0.30, P = .018). In patients without delirium, a strong correlation was found between the 2 behavioral pain scales (0.94, P < .0001) and 2 self-reported pain scales (0.77, P < .0001). Self-reported pain scale (NRS) and behavioral pain scale (CPOT) were poorly correlated with each other (0.28, P = .021). In patients with delirium, there was a strong correlation between behavioral pain scales (0.86, P < .0001) and a moderate correlation between self-reported pain scales (0.69, P < .0001). There was no apparent correlation between self-reported (NRS) and behavioral pain scales (CPOT) in patients with delirium (0.23, P = .12). Most participants preferred self-reported pain assessment.Conclusion:Self-reported pain scales and behavioral pain scales cannot be used interchangeably. Current validated behavioral pain scales may not accurately reflect self-reported pain in critically ill patients.

scholarly journals A Psychometric Analysis Update of Behavioral Pain Assessment Tools for Noncommunicative, Critically Ill Adults

2019 ◽  
Vol 30 (4) ◽  
pp. 365-387 ◽  
Author(s):  
Céline Gélinas ◽  
Aaron M. Joffe ◽  
Paul M. Szumita ◽  
Jean-Francois Payen ◽  
Mélanie Bérubé ◽  
...  
Keyword(s):  
Psychometric Properties ◽  
Critically Ill ◽  
Pain Assessment ◽  
Pain Scale ◽  
Assessment Tools ◽  
Process Reliability ◽  
Behavioral Pain Scale ◽  
Critically Ill Adults ◽  
Ill Adults

This is an updated, comprehensive review of the psychometric properties of behavioral pain assessment tools for use with noncommunicative, critically ill adults. Articles were searched in 5 health databases. A total of 106 articles were analyzed, including 54 recently published papers. Nine behavioral pain assessment tools developed for noncommunicative critically ill adults and 4 tools developed for other non-communicative populations were included. The scale development process, reliability, validity, feasibility, and clinical utility were analyzed using a 0 to 20 scoring system, and quality of evidence was also evaluated. The Behavioral Pain Scale, the Behavioral Pain Scale-Nonintubated, and the Critical-Care Pain Observation Tool remain the tools with the strongest psychometric properties, with validation testing having been conducted in multiple countries and various languages. Other tools may be good alternatives, but additional research on them is necessary.

Assessing pain in non-intubated critically ill patients unable to self report: an adaptation of the Behavioral Pain Scale

2009 ◽  
Vol 35 (12) ◽  
Author(s):  
Gérald Chanques ◽  
Jean-François Payen ◽  
Grégoire Mercier ◽  
Sylvie de Lattre ◽  
Eric Viel ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Pain Scale ◽  
Self Report ◽  
Behavioral Pain Scale

Evaluation of Pain Assessment Tools in Patients Receiving Mechanical Ventilation

2016 ◽  
Vol 27 (2) ◽  
pp. 162-172 ◽  
Author(s):  
Zainab Q. Al Darwish ◽  
Radwa Hamdi ◽  
Summayah Fallatah
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pain Assessment ◽  
Descriptive Study ◽  
Pain Scale ◽  
Assessment Tools ◽  
Highly Sensitive ◽  
Sensitive Tool ◽  
P 16 ◽  
Behavioral Pain Scale

Pain assessment poses a great challenge for clinicians in intensive care units. This descriptive study aimed to find the most reliable, sensitive, and valid tool for assessing pain. The researcher and a nurse simultaneously assessed 47 nonverbal patients receiving mechanical ventilation in the intensive care unit by using 3 tools: the Behavioral Pain Scale (BPS), the Critical-Care Pain Observation Tool (CPOT), and the adult Nonverbal Pain Scale (NVPS) before, during, and after turning and suctioning. All tools were found to be reliable and valid (Cronbach α = 0.95 for both the BPS and the CPOT, α = 0.86 for the NVPS), and all subscales of both the BPS and CPOT were highly sensitive for assessing pain (P &lt; .001). The NVPS physiology (P = .21) and respiratory (P = .16) subscales were not sensitive for assessing pain. The BPS was the most reliable, valid, and sensitive tool, with the CPOT considered an appropriate alternative tool for assessing pain. The NVPS is not recommended because of its inconsistent psychometric properties.

Measurement of the nociceptive flexion reflex threshold in critically ill patients - a monocentric prospective observational study

2021 ◽  
Author(s):  
Benedikt Zujalovic ◽  
Benjamin Mayer ◽  
Steffen Walter ◽  
Sascha Gruss ◽  
Ronald Stitz ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Univariate Analysis ◽  
Pain Scale ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Flexion Reflex ◽  
Nociceptive Flexion Reflex ◽  
Behavioral Pain Scale ◽  
Reflex Threshold

Abstract Background Pain detection and treatment is a major challenge in the care of critically ill patients. However, in addition to the risk of analgesic undersupply, there is also the risk of overanalgesia. In the perioperative context, the measurement of the nociceptive flexion reflex threshold has become established for measuring the level of analgesia. To date, however, it is unclear whether measurement of NFRT can be usefully applied to noncommunicating, ventilated, and analgosedated ICU patients. Therefore, the aim of the present study was to investigate whether NFRT measurement correlates with the Behavioral Pain Scale (BPS) in critically ill, analgosedated, and mechanically ventilated patients and whether it can also detect possible overanalgesia.Methods In this prospective, observational, single-center study, 114 patients were included. All patients were admitted to the surgical Intensive Care Unit of the University hospital Ulm, Germany. First measurements of the NFRT and the Behavioral Pain Scale (BPS) were conducted within 12 hours after admission. In the further observation period, a structured pain assessment was performed at least twice daily until extubation (Group A: BPS + NFRT, Group B: BPS). Univariate analysis was performed to evaluate possible associations between NFRT measurement and baseline characteristics. Furthermore, mixed linear regression modeling was used to evaluate possible effects of administered analgesics or sedatives on NFRT. Results NFRT correlates negatively with the Behavioral Pain Scale. NFRT was almost twice as high in patients with a RASS of -5 compared with patients with a RASS ≥ -4 (RASS -5 - NFRT: 59.40 vs. RASS -4 - NFRT: 29.00, p < 0.001). By means of NFRT measurement, potential overanalgesia could not be detected.Conclusion The NFRT measurement reliably correlates negatively with the Behavioral Pain Scale in critically ill patients. In patients with RASS scores ≤ -4, in whom analgesia level is often difficult to assess, NFRT measurement provides guidance in the assessment of nociceptive processes. However, in order to detect possible overanalgesia and to derive therapeutic consequences, a defined stimulus threshold must be determined for the critically ill patient, above which the absence of pain can be safely assumed.Trial Registration Retrospectively registered at German Clinical Trials Register, registration number DRKS00021149, date of registration: March 26, 2020. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021149

Validation of the Behavioural Indicators of Pain Scale ESCID for pain assessment in non-communicative and mechanically ventilated critically ill patients: a research protocol

2015 ◽  
Vol 72 (1) ◽  
pp. 205-216 ◽  
Author(s):  
Ignacio Latorre-Marco ◽  
Montserrat Solís-Muñoz ◽  
María Acevedo-Nuevo ◽  
María Leonor Hernández-Sánchez ◽  
Candelas López-López ◽  
...  
Keyword(s):  
Critically Ill ◽  
Pain Assessment ◽  
Critically Ill Patients ◽  
Pain Scale ◽  
Research Protocol ◽  
Mechanically Ventilated

scholarly journals Are the current pain assessment tools used by paramedics in Ireland, suitable for use with cognitively impaired (dementia) patients?

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Liam Rooney
Keyword(s):  
Pain Assessment ◽  
Rating Scale ◽  
Assessment Tool ◽  
Hospital Setting ◽  
Reliability And Validity ◽  
Pain Scale ◽  
Assessment Tools ◽  
Self Report ◽  
Good Reliability ◽  
Dementia Patients

<p><span style="text-decoration: underline;"><strong>Background</strong></span></p><p>Dementia is a disease affecting 55,000 Irish people. (1)  It is characterised by progressive cognitive impairment, ranging from mild impairment, which may affect memory, to severe impairment where the ability to communicate may be absent.  These people are at risk of having their pain underassessed and undermanaged. (2)  A survey exploring Irish Paramedics and Advanced Paramedics views on the current pain assessment tools available to them, and whether these tools are suitable for use with dementia patients is proposed.  Existing observational pain assessment tools used with dementia patients are examined and their suitability for pre-hospital use discussed.</p><p><span style="text-decoration: underline;"><strong>Introduction</strong></span></p><p>Adults with cognitive impairments, such as dementia, are at a much higher risk of not receiving adequate analgesia for their pain. (3)  It is estimated between 40% and 80% of dementia patients regularly experience pain. (4)  Current pain assessment tools used pre-hospital in Ireland are: Numerical Rating Scale for patients &gt;8yrs, Wong Baker Scale for pediatric patients and the FLACC Scale for infants.  There is no specific pain assessment tool for use with patients who are not capable of self-reporting their level of pain.</p><p><span style="text-decoration: underline;"><strong>Objective</strong></span></p><p>This research aimed to identify observational pain assessment tools used in this cohort.  The most consistently recommended tools were identified.  The suitability of these tools for use in the pre-hospital setting assessed.</p><p><span style="text-decoration: underline;"><strong>Findings</strong></span></p><p>Literature review identified 29 observational pain assessment tools. There is a lack of literature relating to the pre-hospital setting.  The American Geriatric Society (AGS) identified six pain behaviors in dementia patients, changes in facial expression, activity patterns, interpersonal relationships and mental status, negative vocalisation, change in body language.  These six criteria should be the foundation of any pain assessment tool. (5) The three most consistently recommended tools identified were as follows:</p><p><em>Abbey Pain Scale</em></p><p>6 items assessed, meets AGS criteria, quick and easy to implement, moderate to good reliability and validity (6)</p><p><em>Doloplus 2</em></p><p>15 items assessed, meets 5 of 6 AGS criteria, requires observation over time, prior knowledge of patient required, moderate to good reliability and validity (6)</p><p><em>PAINAD</em></p><p>5 items assessed, meets 3 of 6 AGS criteria, less then 5 minutes to implement, may be influenced by psychological distress, good reliability and validity (6)</p><p> </p><p><span style="text-decoration: underline;"><strong>Conclusion</strong></span></p><p>The ability to self report pain is deemed “gold standard”.  Patients with mild to moderate disease, and indeed, some with severe disease, may retain the ability to self report.  An observational tool is required when dementia has progressed to the point where the patient becomes unable to self report or becomes non-verbal.  It is in these patients where undetected, misinterpreted or inaccurate assessment of pain becomes frequent. (7)  The aim of any tool is to gain a good assessment of pain, however, the pain scale used should be suitable to the clinical setting.  The feasibility of an assessment tool is an important factor along with reliability and validity.  No one assessment tool could be recommended over another.  Abbey and PAINAD have potential for use pre-hospital, however, further research, clinical evaluation and trial in an ambulance service is required.</p>

scholarly journals Pain assessment in critically ill patients in low resource countries

2019 ◽  
pp. S83-S87
Author(s):  
Gauhar Afshan ◽  
Ali Sarfraz Siddiqui
Keyword(s):  
Critically Ill ◽  
Pain Assessment ◽  
Critically Ill Patients ◽  
Developed Countries ◽  
Pain Scale ◽  
Icu Patients ◽  
Low Resource ◽  
The Status ◽  
And Gender ◽  
Pain At Rest

We attempted to review the published literature to find out the status of pain assessment in critically ill patients (CIPs) managing in ICUs of low resource countries. We used broad electronic database (2004-2018) from common search engines. Evidence showed that 33%-61% of the patients in ICU experienced pain at rest and among them 10%-33% of patients experienced moderate to severe pain in developed countries. Prevalence of pain is expected to be high in low resource countries due to huge disease burden of CIPs. The gold standard of pain assessment is self-reporting; however, this is not possible when patients in ICU are unable to communicate. Alternatively, Behavioral Pain Scale (BPS) and Critical Care Pain Observation Tool (CPOT) can be used in this population. These methods/tools are being used in developed countries, however, no evidence is available in low resource countries. The dynamic nature of pain in ICU patients justifies regular pain assessment in all ICU settings. Authors strongly recommend that pain should be objectively assessed in all ICU patients regardless of age and gender using reliable and validated tools like BPS or CPOT.Citation: Afshan G, Siddiqui S. Pain assessment in critically ill patients in low resource countries. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S83-S87

scholarly journals The Impact of Pain Assessment on Critically Ill Patients’ Outcomes: A Systematic Review

2015 ◽  
Vol 2015 ◽  
pp. 1-18 ◽  
Author(s):  
Evanthia Georgiou ◽  
Maria Hadjibalassi ◽  
Ekaterini Lambrinou ◽  
Panayiota Andreou ◽  
Elizabeth D. E. Papathanassoglou
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Quality Assessment ◽  
Critically Ill ◽  
Pain Assessment ◽  
Critically Ill Patients ◽  
Methodological Quality ◽  
Assessment Tools ◽  
Current Evidence ◽  
The Impact

In critically ill patients, pain is a major problem. Efficient pain management depends on a systematic, comprehensive assessment of pain. We aimed to review and synthesize current evidence on the impact of a systematic approach to pain assessment on critically ill patients’ outcomes. A systematic review of published studies (CINAHL, PUBMED, SCOPUS, EMBASE, and COCHRANE databases) with predetermined eligibility criteria was undertaken. Methodological quality was assessed by the EPHPP quality assessment tool. A total of 10 eligible studies were identified. Due to big heterogeneity, quantitative synthesis was not feasible. Most studies indicated the frequency, duration of pain assessment, and types of pain assessment tools. Methodological quality assessment yielded “strong” ratings for 5/10 and “weak” ratings for 3/10 studies. Implementation of systematic approaches to pain assessment appears to associate with more frequent documented reports of pain and more efficient decisions for pain management. There was evidence of favorable effects on pain intensity, duration of mechanical ventilation, length of ICU stay, mortality, adverse events, and complications. This systematic review demonstrates a link between systematic pain assessment and outcome in critical illness. However, the current level of evidence is insufficient to draw firm conclusions. More high quality randomized clinical studies are needed.

Delirium in Critically Ill Patients

2017 ◽  
Author(s):  
Mark van den Boogaard ◽  
Paul Rood
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Hearing Aids ◽  
Critically Ill Patients ◽  
Early Mobilization ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Assessment Tools ◽  
Delirium Assessment ◽  
Nighttime Sleep

This chapter addresses delirium in critically ill patients in the intensive care unit (ICU), especially the mixed subtype (alternating hyperactivity and hypoactivity). The Confusion Assessment Method for the ICU and the Intensive Care Delirium Screening Checklist are discussed as useful delirium assessment tools in this setting. Several neurotransmitter pathways have been implicated in delirium, including cholinergic, GABAergic, and serotonergic pathways; cytokines and glucocorticoids also appear relevant. Risk factors for delirium in the ICU include older age, prior cognitive impairment, worse illness severity, recent delirium or coma, mechanical ventilation, admission category (especially trauma or neurological/neurosurgical admission), infection, metabolic acidosis, morphine and sedative administration, urea concentration, respiratory failure, and admission urgency. Prevention and treatment of delirium are discussed, including nonpharmacological interventions (frequent reorientation, providing eyeglasses and hearing aids if needed, promoting nighttime sleep, and early mobilization) and judicious use of opiate, sedative, and antipsychotic medications.

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