When Patients Can't Communicate Their Pain

New Tool Relies on Behavioral Cues to Identify Severe Pain

Researchers at McGill University, Montreal report that a new assessment tool that gauges observable behavioral cues offers a simple and effective means to measure pain levels in critically ill patients who may be unable to communicate. The Behavior Pain Assessment Tool (BPAT) considers 8 readily observable behaviors that are associated with pain, including facial expressions, verbal cues, and muscle responses. In the international study, the effectiveness of the tool was assessed in 3,850 patients who underwent 4,800 procedures in 192 ICUs. These patients often have impaired ability to communicate about their pain due to sedation, interference from mechanical ventilation, or the critical nature of their condition. But, as the study authors note, "Since none of those conditions precludes the perception of pain, it is essential that clinicians have valid and reliable pain assessment methods." The findings are reported in the journal PAIN®.

In the study population, about two-thirds of patients were able to communicate their pain, allowing for a comparison of BPAT scores to a standard 10-point pain rating score. The study reports that BPAT was effective in identifying patients who were in severe pain, who might benefit from opioid intervention. Study author Céline Gélinas, RN, PhD, commented, "The BPAT was found to be reliable and valid for use in critically ill patients unable to self-report. Valid behavioral pain scales are necessary to ensure appropriate assessment of pain and to guide decisions for pain management in this vulnerable population."

Read more about the assessment tool and the study conclusions here.

The journal abstract may be read here.

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