Assessing pain in critically ill sedated patients by using a behavioral pain scale

Payen, Jean‐François; Bru, Olivier; Bosson, Jean‐Luc; Lagrasta, Anna; Novel, Eric; Deschaux, Isabelle; Lavagne, P.; Jacquot, C.

doi:10.1097/00003246-200112000-00004

Cited by 868 publications

(742 citation statements)

References 19 publications

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“…(6,15) In this study, physiological indicators were recorded less frequently than behavioral indicators in nurses' notes, which was consistent with the findings of a previous study. (9) Many subcategories of behavioral indicators were noted in both the physicians' and the nurses' notes with body movement being the most frequently recorded.…”

Section: Pain Assessmentsupporting

confidence: 92%

“…Ventilator compliance is considered to be a pain related indicator in critically ill intubated patients. Payen et al (15) used ventilator specific behaviors along with other items in developing the Behavioral Pain Scale.…”

Section: Pain Assessmentmentioning

confidence: 99%

“…Previous research indicates that certain behaviors such as grimacing facial expression, rigid body movements, and verbal responses are more specifically related to pain. (9,15,25) Body language can be used as a means of identifying the need for pain management interventions or reassessing the effectiveness of these interventions provided to relieve pain, especially in patients who are unable to communicate. (25) Some behavioral indicators in the present study were recorded by either physicians or nurses, but not by both.…”

Section: Pain Assessmentmentioning

confidence: 99%

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Pain Assessment and Management in Critically Ill Intubated Patients in Jordan : A Prospective Study

Ayasrah¹,

O'Neill²,

Abdalrahim³

et al. 2014

IJHS

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Abstract:Objectives: The purpose of this study was to describe: (1) pain indicators used by nurses and physicians to assess pain, (2) pain management interventions (pharmacological and non-pharmacological) used by nurses, and (3) indicators used by nurses to verify pain intervention effectiveness. Methodology:A total of 301 medical records of currently admitted patients from six different ICUs in Jordan were reviewed using a data collection instrument developed by Gélinas et al. (2004) Pain-related indicators were classified into non-observable (patient's self-reports of pain) and observable (physiological and behavioral) categories. Results:Only 105 (35%) of a total 301 reviewed medical records contained pain assessment data. From these medical records, 15 pain episodes were collected altogether. Observable indicators documented 98% of the 115 pain episodes. Patients' selfreports of pain were documented only 1.7% of the time. In 78% and 46% of the 115 pain episodes, pharmacological and nonpharmacological interventions for pain management were documented, respectively. Only 37% of the pain episodes were reassessed with self-report (1%) and observable indicators (36%) to determine the effectiveness of the interventions. Conclusion:Pain documentation for assessment, management, and reassessment was lacking and needs improvement.

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Section: Pain Assessmentsupporting

confidence: 92%

Section: Pain Assessmentmentioning

confidence: 99%

Section: Pain Assessmentmentioning

confidence: 99%

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Pain Assessment and Management in Critically Ill Intubated Patients in Jordan : A Prospective Study

Ayasrah¹,

O'Neill²,

Abdalrahim³

et al. 2014

IJHS

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“…To address these challenges, guidelines have been developed in both Europe 13 and the USA 14. The American College of Critical Care Medicine (ACCM) 14 has emphasised the need for regular pain assessment along with the use of validated tools, such as the critical care pain observational tool (CPOT) 15, and the behavioural pain scale (BPS) 16. Despite their dissemination, recent surveys indicate limited use among nursing staff 17, 18.…”

Section: Introductionmentioning

confidence: 99%

Pain Assessment in INTensive care (PAINT): an observational study of physician‐documented pain assessment in 45 intensive care units in the United Kingdom

et al. 2017

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SummaryPain is a common and distressing symptom experienced by intensive care patients. Assessing pain in this environment is challenging, and published guidelines have been inconsistently implemented. The Pain Assessment in INTensive care (PAINT) study aimed to evaluate the frequency and type of physician pain assessments with respect to published guidelines. This observational service evaluation considered all pain and analgesia‐related entries in patients’ records over a 24‐h period, in 45 adult intensive care units (ICUs) in London and the South‐East of England. Data were collected from 750 patients, reflecting the practice of 362 physicians. Nearly two‐thirds of patients (n = 475, 64.5%, 95%CI 60.9–67.8%) received no physician‐documented pain assessment during the 24‐h study period. Just under one‐third (n = 215, 28.6%, 95%CI 25.5–32.0%) received no nursing‐documented pain assessment, and over one‐fifth (n = 159, 21.2%, 95%CI 19.2–23.4)% received neither a doctor nor a nursing pain assessment. Two of the 45 ICUs used validated behavioural pain assessment tools. The likelihood of receiving a physician pain assessment was affected by the following factors: the number of nursing assessments performed; whether the patient was admitted as a surgical patient; the presence of tracheal tube or tracheostomy; and the length of stay in ICU. Physician‐documented pain assessments in the majority of participating ICUs were infrequent and did not utilise recommended behavioural pain assessment tools. Further research to identify factors influencing physician pain assessment behaviour in ICU, such as human factors or cultural attitudes, is urgently needed.

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“…Both PAD guidelines recommend (grade +1B) routine monitoring of pain in adult patients in the ICU. Although the FEPIMCTI guidelines recommend using a validated behavioral pain scale to monitor the pain of patients who are unable to communicate, they have yet to recommend (only introduce) using the Behavioral Pain Scale or the Critical‐Care Pain Observation Tool, which are the most valid and reliable pain scales according to both PAD guidelines 9, 10…”

Section: Reviewmentioning

confidence: 99%

Comparison of clinical practice guidelines for the management of pain, agitation, and delirium in critically ill adult patients

Tsuruta

Fujita

2018

Acute Medicine & Surgery

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Guideline‐based management approaches for pain, agitation, and delirium (PAD) in critically ill adult patients are widely believed to result in good outcomes. However, there are some differences in the recommendations and evidence levels among the management guidelines established for PAD. To identify and compare the current management guidelines, we used the PubMed database. The PAD guidelines and Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva (FEPIMCTI) guidelines were identified from our search. We compared the main aspects of these two guidelines as well as the Japanese guidelines for the management of PAD (J‐PAD guidelines). The PAD, FEPIMCTI, and J‐PAD guidelines contained a total of 4, 12, and 5 sections, having 32, 138, and 37 recommendations, respectively, pertaining to routine monitoring of pain in adult patients in the intensive care unit. Intravenous opioids were recommended as the first‐line drug of choice for treating pain. Sedative titrated to maintain a light, rather than deep, level of sedation can be given unless clinically contraindicated. Although neither the PAD nor J‐PAD guidelines recommend use of a pharmacologic delirium prevention protocol or treatment with any pharmacological agent to reduce the duration of delirium, the FEPIMCTI guidelines provide such recommendations. The FEPIMCTI guidelines provide suggestions on which analgesics to use for several different cases and present algorithms for sedation and analgesia. The outlines of the three guidelines are similar, and all reinforce the management of PAD to improve patient outcomes.

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Assessing pain in critically ill sedated patients by using a behavioral pain scale

Cited by 868 publications

References 19 publications

Pain Assessment and Management in Critically Ill Intubated Patients in Jordan : A Prospective Study

Pain Assessment and Management in Critically Ill Intubated Patients in Jordan : A Prospective Study

Pain Assessment in INTensive care (PAINT): an observational study of physician‐documented pain assessment in 45 intensive care units in the United Kingdom

Comparison of clinical practice guidelines for the management of pain, agitation, and delirium in critically ill adult patients

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