Clinical Utility of the Behavioral Pain Assessment Tool in Patients Admitted in the Intensive Care Unit
Sukanya Mitra, Kompal Jain, Jasveer Singh, Puja Saxena, Tenzin Nyima, Selwin R Selvam, Mansi C Walia
Assessment, Intensive care unit, Management, Pain, Scale, Utility
Citation Information :
Mitra S, Jain K, Singh J, Saxena P, Nyima T, Selvam SR, Walia MC. Clinical Utility of the Behavioral Pain Assessment Tool in Patients Admitted in the Intensive Care Unit. Indian J Crit Care Med 2020; 24 (8):695-700.
Introduction: Unnoticed and unrelieved pain is one of the main sources of psychological and physiological stress for intensive care unit (ICU) patients. The eight-item behavior pain assessment tool (BPAT) is a multicountry validated tool to assess pain in ICU patients. However, its feasibility and clinical utility for ICU patients in India need further research. Aims and objectives: The Aims and objectives of the study were to assess pain using BPAT and its clinical utility in pain assessment and management in ICU patients. Materials and methods: Following ethical approval, 400 consecutive adult patients admitted in the ICUs in a tertiary care teaching hospital were assessed for pain severity using BPAT at intake, baseline pain and procedural pain. Patients <18 years and in deep coma on the Glasgow coma scale were excluded from the study. The patients with BPAT score ≥4 were given opioid analgesic, and their pain was reassessed after 2–3 hours. A feedback regarding feasibility and clinical utility was filled by the doctors. Results: High interrater agreement for BPAT was observed with excellent kappa coefficients (>0.85) for each item. The BPAT significantly guided the pain management (p < 0.0001). More than 90% of doctors found BPAT easy to understand and use. In most of the cases (95.5%), doctors agreed that BPAT can improve the clinical management of ICU patients. Conclusion: The BPAT is a reliable, brief, and an easy-to-use pain assessment tool, which clinicians can use for guiding pain assessment and management in the ICU setting on a routine basis. Clinical significance: We recommend implementing BPAT in the clinical practice for better pain assessment and control in ICU patients.
Puntillo K, White C, Morris A, Perdue S, Stanik-Hutt J, Thompson C, et al. Patients’ perceptions and responses to procedural pain: results from thunder project II. Am J Crit Care 2001;10(4):238–251. DOI: 10.4037/ajcc2001.10.4.238.
Narayanan M, Venkataraju A, Jennings J. Analgesia in intensive care: part 1. BJA Education 2016;16(2):72–78. DOI: 10.1093/bjaceaccp/mkv018.
Puntillo KA, Max A, Timsit JF, Vignoud L, Chanques G, Robleda G, et al. Determinants of procedural pain intensity in the intensive care unit. Am J Respir Crit Care Med 2014;189(1):39–47. DOI: 10.1164/rccm.201306-1174OC.
Gelinas C, Puntillo KA, Levin P, Azoulay E. The behavior pain assessment tool for critically ill adults: a validation study in 28 countries. Pain 2017;158(5):811–821. DOI: 10.1097/j.pain.0000000000000834.
Gelinas C. Nurses’ evaluations of the feasibility and clinical utility of the critical care pain observational tool. Pain Manag Nurs 2010;11(2):115–125. DOI: 10.1016/j.pmn.2009.05.002.
Smart A. A multi-dimensional model of clinical utility. Int J Qual Health C 2006;18(5):377–382. DOI: 10.1093/intqhc/mzl034.
Rostad HM, Utne I, Grov EK, Puts M, Halvorsrud L. Measurement properties, feasibility and clinical utility of the Doloplus-2 pain scale in older adults with cognitive impairment: asystematic review. BMC Geriatr 2017;17(1):257–285. DOI: 10.1186/s12877-017-0643-9.
Richard LM, Williams V, Bernard F, Tsoller D, Gélinas C. Nurses’ evaluations of the feasibility and clinical utility of the use of the critical-care pain observation tool-neuro in critically ill brain-injured patients. SNAHP 2019. 2. DOI: 10.31770/2561-7516.1045.
Pathak A, Sharma S, Jensen MP. The utility and validity of pain intensity rating scales for use in developing countries. Pain Rep 2018(5):e672. DOI: 10.1097/PR9.0000000000000672.
Teasdale G, Allen D, Brennan P, McElhinney E, Mackinnon L. The Glasgow coma scale: an update after 40 years. Nurs Times 2014;110:12–16.
Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Hals BEK. Assessment of pain. BJA 2008;101(1):17–24. DOI: 10.1093/bja/aen103.
Gouda MA. Common pitfalls in reporting the use of SPSS software. Med Princ Pract 2015;24(3):300. DOI: 10.1159/000381953.
Santos IFA, DeSantana JM. Pain measurement techniques: spotlight on mechanically ventilated patients. J Pain Res 2018;11:2969–2980. DOI: 10.2147/JPR.S151169.
Khanna P, Pandey RK, Chandralekha C, Sharma A, Pangasa N. Comparison between critical-care pain observation tool and physiologic indicators for pain assessment in the critically ill, mechanically ventilated adult patients. Saudi J Anaesth 2018;12(3):384–388. DOI: 10.4103/sja.SJA_642_17.
Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, et al. 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. DOI: 10.1097/CCM.0b013e3182783b72.
Gélinas C, Arbour C. Behavioral and physiological indicators during a nociceptive procedure in conscious and unconscious mechanically ventilated adults: similar or different? J Crit Care 2009;24(4):628.e7–17. DOI: 10.1016/j.jcrc.2009.01.013.
Naithani U, Bajaj P, Chhabra S. Assessment of sedation and analgesia in mechanically ventilated patients in intensive care unit. Indian J Anaesth 2008;52:519.
Deborah BM, Karen SK, Mary EH-W, Florence I. Pain assessment in Non-communicative adult palliative care patients. NursClin North Am 2016;51(3):397–431. DOI: 10.1016/j.cnur.2016.05.009.
Gélinas C, Joffe AM, Szumita PM, Payen JF, Bérubé M, Shahiri T. S, et al. A psychometric analysis update of behavioral pain assessment tools for noncommunicative, critically ill adults. AACN Adv Crit Care 2019;30(4):365–387. DOI: 10.4037/aacnacc2019952.
Chanques G, Pohlman A, Molinari N, Jong AD, Jaber S, Kress JP. Psychometric comparison of three behavioural scales for the assessment of pain in critically ill patients unable to self-report. Crit Care 2014(5):18. DOI: 10.1186/cc14000.
Aïssaoui Y, Zeggwagh AA, Zekraoui A, Abidi K, Abouqal R. Validation of a behavioral pain scale in critically ill, sedated, and mechanically ventilated patients. Anesth Analg 2005;101(5):1470–1476. DOI: 10.1213/01.ANE.0000182331.68722.FF.
Czarnecki ML, Turner HN, Collins PM, Doellman D, Wrona S, Reynolds J. Procedural pain management: a position statement with clinical practice recommendations. Pain Manag Nurs 2011;12(2):95–111. DOI: 10.1016/j.pmn.2011.02.003.
Payen J-F, Bru O, Bosson J-L, Lagrasta A, Novel E, Deschaux I, et al. Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med 2001;29(12):2258–2263. DOI: 10.1097/00003246-200112000-00004.
Gélinas C, Fillion L, Puntillo KA, Viens C, Fortier M. Validation of the critical-care pain observation tool in adult patients. Am J Crit Care 2006;15(4):420–427. DOI: 10.4037/ajcc2006.15.4.420.
Young J, Siffleet J, Nikoleeti S, Shaw T. Use of behavioural pain scale to assess pain in ventilated, unconscious and/or sedated patients. Intens Crit care nur 2006;22(1):32–39. DOI: 10.1016/j.iccn.2005.04.004.
Payen JF, Chanques G, Mantz J, Hercule C, Auriant I, Leguillou JL, et al. Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study. Anesth 2007;106(4):687–695. DOI: 10.1097/01.anes.0000264747.09017.da.
Georgiou E, Hadjibalassi M, Lambrinou E, Andreou P, Papathanassoglou E. The impact of pain assessment on critically ill patients’ outcomes: a systematic review. Biomed Res Int 2015. DOI: http://dx.doi.org/10.1155/2015/503830.
Puntillo AK, Max A, Chaize M, Chanques G, Azoulay E. Patient recollection of ICU procedural pain and post ICU burden: the memory study. Crit Care Med 2016;44(11):1988–1995. DOI: 10.1097/CCM.0000000000001875.
Gelinas C. Pain management challenges in acute and critically ill patients. AACN Adv Crit Care 2019;30(4):318–319. DOI: 10.4037/aacnacc2019132.
Arroyo-Novoa CM, Figueroa-Ramos MI, Puntillo KA. Opioid and benzodiazepine iatrogenic withdrawal syndrome in patients in the intensive care unit. AACN Adv Crit Care 2019;30(4):353–364. DOI: 10.4037/aacnacc2019267.