open access

Vol 49, No 1 (2017)
Review articles
Published online: 2017-03-31
Submitted: 2017-01-27
Accepted: 2017-02-18
Get Citation

Methods of pain assessment in adult intensive care unit patients — Polish version of the CPOT (Critical Care Pain Observation Tool) and BPS (Behavioral Pain Scale)

Katarzyna Kotfis, Małgorzata Zegan-Barańska, Łukasz Szydłowski, Maciej Żukowski, Eugene W. Ely
DOI: 10.5603/AIT.2017.0010
·
Pubmed: 28362033
·
Anaesthesiol Intensive Ther 2017;49(1):66-72.

open access

Vol 49, No 1 (2017)
Review articles
Published online: 2017-03-31
Submitted: 2017-01-27
Accepted: 2017-02-18

Abstract

Many patients treated in the intensive care unit (ICU) experience pain that is a source of suffering and leaves a longterm imprint (chronic pain, post-traumatic stress disorder). Nearly 30% of patients experience pain at rest, while the percentage increases to 50% during nursing procedures. Pain in ICU patients can be divided into four categories: continuous ICU treatment-related pain/discomfort, acute illness-related pain, intermittent procedural pain and pre-existing chronic pain present before ICU admission. As daily nursing procedures and interventions performed in the ICU may be a potential source of pain, it is crucial to use simple pain monitoring tools. The assessment of pain intensity in ICU patients remains an everyday challenge for clinicians, especially in sedated, intubated and mechanically ventilated patients. Regular assessment of pain intensity leads to improved outcome and better quality of life of patients in the ICU and after discharge from ICU. The gold standard in pain evaluation is patient self-reporting, which is not always possible. Current research shows that the two tools best validated for patients unable to self-report pain are the Behavioral Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT). Although international guidelines recommend the use of validated tools for pain evaluation, they underline the need for translation into a given language. The authors of this publication obtained an official agreement from the authors of the two behavioral scales — CPOT and BPS — for translation into Polish. Validation of these tools in the Polish population will aid their wider use in pain assessment in ICUs in Poland.

Abstract

Many patients treated in the intensive care unit (ICU) experience pain that is a source of suffering and leaves a longterm imprint (chronic pain, post-traumatic stress disorder). Nearly 30% of patients experience pain at rest, while the percentage increases to 50% during nursing procedures. Pain in ICU patients can be divided into four categories: continuous ICU treatment-related pain/discomfort, acute illness-related pain, intermittent procedural pain and pre-existing chronic pain present before ICU admission. As daily nursing procedures and interventions performed in the ICU may be a potential source of pain, it is crucial to use simple pain monitoring tools. The assessment of pain intensity in ICU patients remains an everyday challenge for clinicians, especially in sedated, intubated and mechanically ventilated patients. Regular assessment of pain intensity leads to improved outcome and better quality of life of patients in the ICU and after discharge from ICU. The gold standard in pain evaluation is patient self-reporting, which is not always possible. Current research shows that the two tools best validated for patients unable to self-report pain are the Behavioral Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT). Although international guidelines recommend the use of validated tools for pain evaluation, they underline the need for translation into a given language. The authors of this publication obtained an official agreement from the authors of the two behavioral scales — CPOT and BPS — for translation into Polish. Validation of these tools in the Polish population will aid their wider use in pain assessment in ICUs in Poland.

Get Citation

Keywords

pain, assessment; behavioural scales, CPOT, BPS; critical care

About this article
Title

Methods of pain assessment in adult intensive care unit patients — Polish version of the CPOT (Critical Care Pain Observation Tool) and BPS (Behavioral Pain Scale)

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 49, No 1 (2017)

Pages

66-72

Published online

2017-03-31

DOI

10.5603/AIT.2017.0010

Pubmed

28362033

Bibliographic record

Anaesthesiol Intensive Ther 2017;49(1):66-72.

Keywords

pain
assessment
behavioural scales
CPOT
BPS
critical care

Authors

Katarzyna Kotfis
Małgorzata Zegan-Barańska
Łukasz Szydłowski
Maciej Żukowski
Eugene W. Ely

References (46)
  1. Pain terms: a list with definitions and notes on usage. Recommended by the IASP Subcommittee on Taxonomy. Pain. 1979; 6(3): 249.
  2. Carrothers KM, Barr J, Spurlock B, et al. American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013; 41(1): 263–306.
  3. Baron R, Binder A, Biniek R, et al. DAS-Taskforce 2015. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version. Ger Med Sci. 2015; 13: Doc19.
  4. Vincent JL, Shehabi Y, Walsh TS, et al. Comfort and patient-centred care without excessive sedation: the eCASH concept. Intensive Care Med. 2016; 42(6): 962–971.
  5. Seya MJ, Gelders SF, Achara OU, et al. A first comparison between the consumption of and the need for opioid analgesics at country, regional, and global levels. J Pain Palliat Care Pharmacother. 2011; 25(1): 6–18.
  6. Desbiens NA, Wu AW. Pain and suffering in seriously ill hospitalized patients. J Am Geriatr Soc. 2000; 48(5 Suppl): S183–S186.
  7. Li DT, Puntillo K. A pilot study on coexisting symptoms in intensive care patients. Appl Nurs Res. 2006; 19(4): 216–219.
  8. Chanques G, Sebbane M, Barbotte E, et al. A prospective study of pain at rest: incidence and characteristics of an unrecognized symptom in surgical and trauma versus medical intensive care unit patients. Anesthesiology. 2007; 107(5): 858–860.
  9. Ballard KS. Identification of environmental stressors for patients in a surgical intensive care unit. Issues Ment Health Nurs. 1981; 3(1-2): 89–108.
  10. So HM, Chan DS. Perception of stressors by patients and nurses of critical care units in Hong Kong. Int J Nurs Stud. 2004; 41(1): 77–84.
  11. Rotondi AJ, Chelluri L, Sirio C, et al. Patients' recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit. Crit Care Med. 2002; 30(4): 746–752.
  12. Shannon K, Bucknall T. Pain assessment in critical care: what have we learnt from research. Intensive Crit Care Nurs. 2003; 19(3): 154–162.
  13. Anand KJ, Craig KD. New perspectives on the definition of pain. Pain. 1996; 67(1): 3–6; discussion 209.
  14. Puntillo KA, Arai S, Cohen NH, et al. Pain experiences of intensive care unit patients. Heart Lung. 1990; 19(5 Pt 1): 526–533.
  15. Chanques G, Pohlman A, Kress JP, et al. Psychometric comparison of three behavioural scales for the assessment of pain in critically ill patients unable to self-report. Crit Care. 2014; 18(5): R160.
  16. Stanik-Hutt JA, Soeken KL, Belcher AE, et al. Pain experiences of traumatically injured patients in a critical care setting. Am J Crit Care. 2001; 10(4): 252–259.
  17. Stotts NA, Puntillo K, Bonham Morris A, et al. Wound care pain in hospitalized adult patients. Heart Lung. 2004; 33(5): 321–332.
  18. Arroyo-Novoa CM, Figueroa-Ramos MI, Puntillo KA, et al. Pain related to tracheal suctioning in awake acutely and critically ill adults: a descriptive study. Intensive Crit Care Nurs. 2008; 24(1): 20–27.
  19. Puntillo KA, Wild LR, Morris AB, et al. Practices and predictors of analgesic interventions for adults undergoing painful procedures. Am J Crit Care. 2002; 11(5): 415–29; quiz 430.
  20. Siffleet Jo, Young J, Nikoletti S, et al. Patients' self-report of procedural pain in the intensive care unit. J Clin Nurs. 2007; 16(11): 2142–2148.
  21. Jones J, Hoggart B, Withey J, et al. What the patients say: A study of reactions to an intensive care unit. Intensive Care Med. 1979; 5(2): 89–92.
  22. Gélinas C. Management of pain in cardiac surgery ICU patients: have we improved over time? Intensive Crit Care Nurs. 2007; 23(5): 298–303.
  23. Granja C, Gomes E, Amaro A, et al. JMIP Study Group. Understanding posttraumatic stress disorder-related symptoms after critical care: the early illness amnesia hypothesis. Crit Care Med. 2008; 36(10): 2801–2809.
  24. Schelling G, Richter M, Roozendaal B, et al. Exposure to high stress in the intensive care unit may have negative effects on health-related quality-of-life outcomes after cardiac surgery. Crit Care Med. 2003; 31(7): 1971–1980.
  25. Chapman CR, Tuckett RP, Song CW. Pain and stress in a systems perspective: reciprocal neural, endocrine, and immune interactions. J Pain. 2008; 9(2): 122–145.
  26. Akça O, Melischek M, Scheck T, et al. Postoperative pain and subcutaneous oxygen tension. Lancet. 1999; 354(9172): 41–42.
  27. Beilin B, Shavit Y, Hart J, et al. Effects of anesthesia based on large versus small doses of fentanyl on natural killer cell cytotoxicity in the perioperative period. Anesth Analg. 1996; 82(3): 492–497.
  28. Pollock RE, Lotzová E, Stanford SD. Mechanism of surgical stress impairment of human perioperative natural killer cell cytotoxicity. Arch Surg. 1991; 126(3): 338–342.
  29. Peterson PK, Chao CC, Molitor T, et al. Stress and pathogenesis of infectious disease. Rev Infect Dis. 1991; 13(4): 710–720.
  30. Marmo L, Fowler S. Pain assessment tool in the critically ill post-open heart surgery patient population. Pain Manag Nurs. 2010; 11(3): 134–140.
  31. Young J, Siffleet Jo, Nikoletti S, et al. Use of a Behavioural Pain Scale to assess pain in ventilated, unconscious and/or sedated patients. Intensive Crit Care Nurs. 2006; 22(1): 32–39.
  32. Gélinas C, Arbour C. Behavioral and physiologic indicators during a nociceptive procedure in conscious and unconscious mechanically ventilated adults: similar or different? J Crit Care. 2009; 24(4): 628.e7–628.17.
  33. Chanques G, Viel E, Constantin JM, et al. The measurement of pain in intensive care unit: comparison of 5 self-report intensity scales. Pain. 2010; 151(3): 711–721.
  34. Li D, Puntillo K, Miaskowski C. A review of objective pain measures for use with critical care adult patients unable to self-report. J Pain. 2008; 9(1): 2–10.
  35. Chanques G, Jaber S, Barbotte E, et al. Impact of systematic evaluation of pain and agitation in an intensive care unit. Crit Care Med. 2006; 34(6): 1691–1699.
  36. Payen JF, Bosson JL, Chanques G, et al. DOLOREA Investigators. Pain assessment is associated with decreased duration of mechanical ventilation in the intensive care unit: a post Hoc analysis of the DOLOREA study. Anesthesiology. 2009; 111(6): 1308–1316.
  37. Frandsen JB, O'Reilly Poulsen KS, Laerkner E, et al. Validation of the Danish version of the Critical Care Pain Observation Tool. Acta Anaesthesiol Scand. 2016; 60(9): 1314–1322.
  38. Li Q, Wan X, Gu C, et al. Pain assessment using the critical-care pain observation tool in Chinese critically ill ventilated adults. J Pain Symptom Manage. 2014; 48(5): 975–982.
  39. Aïssaoui Y, Zeggwagh AA, Zekraoui A, et al. Validation of a behavioral pain scale in critically ill, sedated, and mechanically ventilated patients. Anesth Analg. 2005; 101(5): 1470–1476.
  40. Ahlers SJ, van Gulik L, van der Veen AM, et al. Comparison of different pain scoring systems in critically ill patients in a general ICU. Crit Care. 2008; 12(1): R15.
  41. Ahlers SJ, van der Veen AM, van Dijk M, et al. The use of the Behavioral Pain Scale to assess pain in conscious sedated patients. Anesth Analg. 2010; 110(1): 127–133.
  42. Gélinas C, Fillion L, Puntillo KA, et al. Validation of the critical-care pain observation tool in adult patients. Am J Crit Care. 2006; 15(4): 420–427.
  43. Gélinas C, Puntillo KA, Joffe AM, et al. A validated approach to evaluating psychometric properties of pain assessment tools for use in nonverbal critically ill adults. Semin Respir Crit Care Med. 2013; 34(2): 153–168.
  44. Payen JF, Chanques G, Mantz J, et al. Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study. Anesthesiology. 2007; 106(4): 687–95; quiz 891.
  45. Severgnini P, Pelosi P, Contino E, et al. Accuracy of Critical Care Pain Observation Tool and Behavioral Pain Scale to assess pain in critically ill conscious and unconscious patients: prospective, observational study. J Intensive Care. 2016; 4: 68.
  46. Payen JF, Bru O, Bosson JL, et al. Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med. 2001; 29(12): 2258–2263.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

VM Media sp. z o.o. VM Group sp.k., Grupa Via Medica, Świętokrzyska 73 St., 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl