Pain assessment of traumatic brain injury victims using the Brazilian version of the 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 < .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.

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Validation of the Brazilian version of Behavioral Pain Scale in adult sedated and mechanically ventilated patients

Brazilian Journal of Anesthesiology (English Edition) ◽

10.1016/j.bjane.2015.11.003 ◽

2017 ◽

Vol 67 (3) ◽

pp. 271-277

Author(s):

Isabela Freire Azevedo-Santos ◽

Iura Gonzalez Nogueira Alves ◽

Manoel Luiz de Cerqueira Neto ◽

Daniel Badauê-Passos ◽

Valter Joviniano Santana-Filho ◽

...

Keyword(s):

Pain Scale ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Brazilian Version ◽

Behavioral Pain Scale ◽

Ventilated Patients

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Review for "Application of the Behavioral Indicators of Pain Scale in Patients with Traumatic Brain Injury"

10.1111/jan.14400/v2/review3 ◽

2020 ◽

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Pain Scale ◽

Behavioral Indicators

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Review for "Application of the Behavioral Indicators of Pain Scale in Patients with Traumatic Brain Injury"

10.1111/jan.14400/v1/review1 ◽

2019 ◽

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Pain Scale ◽

Behavioral Indicators

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Pain assessment using a Polish version of the Behavioral Pain Assessment Scale in sedated and mechanically ventilated patients

Ból ◽

10.5604/01.3001.0009.5271 ◽

2016 ◽

Vol 17 (3) ◽

pp. 27-35

Author(s):

Aleksandra Gutysz-Wojnicka ◽

Dorota Ozga ◽

Ewa Mayzner-Zawadzka

Keyword(s):

Critical Care ◽

Clinical Practice ◽

Pain Assessment ◽

Pain Scale ◽

Adult Patients ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Polish Version ◽

Behavioral Pain Scale ◽

Ventilated Patients

“Gold standard” in the assessment of pain is patient’s subjective assessment by means of standardized numerical, analog-visual or verbal scales. Unconscious, sedated, mechanically ventilated patients are able to subjectively assess pain in this way. Clinical practice guidelines for the management of pain, agitation and delirium in adult patients in the intensive care unit developed by a working group of the American College of Critical Care Medicine (ACCCM) state that adult patients treated in the ICU routinely experience pain at rest and during routine care. The guidelines recommend routine monitoring of pain in all adult patients in the ICU using the Behavioral Pain Scale (BPS) or Critical-Care Pain Observation Tool (CPOT). Cultural adaptation was conducted in Poland, psychometric properties of Polish version of Behavioral Pain Scale (BPS) were evaluated. Internal consistency determined by Cronbach’s alpha amounted to 0.6883. The correlation coefficients between items of the scale and the sum score in the pain phase were in the range 0.27-0.28. The analysis of principal components confirmed that all the components of the scale respectively, the face, the upper limbs, synchronization with the respirator are one factor and explain 63.9% of the rating variation, while discriminatory accuracy of the scale was unconfirmed. The value of pain assessment using the Polish version of BPS increased significantly, also in the case of routine painless procedures, most likely due to other factors. That prevented the unambiguous interpretation of the results of the pain assessment and enforced additional data from other sources in the assessment of pain. The reason for the lack of discriminant accuracy can be vague operationalization of the scale indicators especially in the category: Face and Synchronization with the ventilator and the lack of adequate training for personnel in scale application. The aim of the study was to prepare the Polish version of Behavioral Pain Scale (BPS) with more favorable psychometric properties. Based on the analysis of the literature individual scale indicators included in the categories of Face and Synchronization with the ventilator and the scheme of their scoring were re-defined. The result of the study is modified Polish version of BPS. Conclusions: The validation process of the research tool is not a one-time process. The implementation of the scale into clinical practice is required as well as further monitoring of its reliability and validity indicators. It is necessary to implement the system of personnel training in BPS application

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Application of the Behavioural Indicators of Pain Scale in patients with traumatic brain injury

Journal of Advanced Nursing ◽

10.1111/jan.14400 ◽

2020 ◽

Vol 76 (7) ◽

pp. 1862-1870

Author(s):

Candelas López‐López ◽

Antonio Arranz‐Esteban ◽

Susana Arias‐Rivera ◽

Montserrat Solís‐Muñoz ◽

Teresa Pérez‐Pérez ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Pain Scale

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

Journal of Intensive Care Medicine ◽

10.1177/0885066618757450 ◽

2018 ◽

Vol 35 (5) ◽

pp. 453-460 ◽

Cited By ~ 6

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.

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