Behavioral Pain Indicators in Patients with Traumatic Brain Injury Admitted to an Intensive Care Unit

Abstract

Introduction: A consistent approach to pain assessment for patients admitted to intensive care unit (ICU) is a major difficulty for health practitioners due to some patients’ inability, to express their pain verbally. This study aimed to assess pain behaviors (PBs) in traumatic brain injury (TBI) patients at different levels of consciousness. Methods: This study used a repeated-measure, within-subject design with 35 patients admitted to an ICU. The data were collected through observations of nociceptive and non-nociceptive procedures, which were recorded through a 47-item behavior-rating checklist. The analyses were performed by SPSS ver.13 software. Results: The most frequently observed PBs during nociceptive procedures were facial expression levator contractions (65.7%), sudden eye openings (34.3%), frowning (31.4%), lip changes (31.4%), clear movement of extremities (57.1%), neck stiffness (42.9%), sighing (31.4%), and moaning (31.4%). The number of PBs exhibited by participants during nociceptive procedures was significantly higher than those observed before and 15 minutes after the procedures. Also, the number of exhibited PBs in patients during nociceptive procedures was significantly greater than that of exhibited PBs during the non-nociceptive procedure. The results showed a significant difference between different levels of consciousness and also between the numbers of exhibited PBs in participants with different levels of traumatic brain injury severity. Conclusion: The present study showed that most of the behaviors that have been observed during painful stimulation in patients with traumatic brain injury included facial expressions, sudden eye opening, frowning, lip changes, clear movements of extremities, neck stiffness, and sighing or moaning.

Evaluation of Vital Signs’ Fluctuations and Behavioral Responses in the Assessment of Pain in Patients With Traumatic Brain Injury

“…Our results showed that behavioral responses may be valuable indicators of pain assessment in TBI patients. Likewise, American nursing society and the society of critical care suggest behavioral responses for pain detection in patients who are not able to express their pain since these responses rely on the individual pain tolerance and usually manifest in appearance and body movements such as squeezing teeth, holding the painful part, bending, moaning, crying, and uneasiness (29).…”

Strengthening Post-Operative Pain Assessment in Patients with Major Abdominal Surgery, University Teaching Hospitals, Zambia

“…In phase II, 88% of the participants reported likewise and in phase III, the results were similar although the percentage of participants who indicated so fairly reduced to 64%. In individuals who are unable to self-report pain due to various reasons, pain indicators may present as behaviours that are characteristic of other unmet needs [24]. The pain behaviour presents the way in which someone, in this case the clinician, can see that the other person (patient) is in pain.…”

Analgesia in the Neurosurgical Intensive Care Unit

“…The parameters evaluated by these tools are physiologic parameters, verbal response, motor response, or facial mimic, which may be irreversibly impaired by brain damage. A study conducted by Nazari and coworkers showed that most of the behaviors that have been observed during painful stimulation in patients with traumatic brain injury included facial expressions, sudden eyeopening, frowning, lip changes, clear movements of extremities, neck stiffness, and sighing or moaning (22). Using these tools may be helpful, but also misleading in patients with brain edema after hypoxic brain injury, or in patients with intracranial hemorrhage and hypertension.…”