A new Behaviour Pain Assessment Tool (BPAT) provides a simple way to evaluate pain in critically ill patients, including those who aren’t able to communicate their pain verbally, according to a study published in the journal Pain.
Based on 8 observable pain behaviours, the BPAT is particularly useful in identifying patients experiencing severe pain during procedures in the intensive care unit (ICU), according to the report by Céline Gélinas, PhD, McGill University, Montreal, Quebec, colleagues.
The researchers evaluated the BPAT’s ability to assess procedure-related pain in critically ill adults. Many patients in the ICU are unable to communicate their pain because their clinical condition, altered level of consciousness, or mechanical ventilation and sedation prevents them from doing so.
“Since none of those conditions precludes the perception of pain, it is essential that clinicians have valid and reliable pain assessment methods,” the authors wrote.
The BPAT used readily observable behaviours — facial expressions, verbal responses, and muscle responses — as potential indicators of pain during the procedures. Translated into 12 languages, the BPAT was evaluated during more than 4,800 procedures in 3,850 patients who were hospitalised in 192 ICUs in 28 countries.
About two-thirds of patients were able to communicate their pain. In this group, pain intensity and distress were rated on a standard ten-point scale, in addition to the BPAT.
Most of the 8 pain behaviours became more frequent during the procedure, compared with before the procedure. Facial grimacing was the most commonly observed behaviour. Other pain indicators included wincing, moaning, verbal complaints, and clenched fists.
The 8-point BPAT score was significantly related to the pain ratings made by patients who were able to communicate. At a cut-off point of higher than 3.5, the BPAT performed well in identifying patients with severe levels of pain intensity and distress who might benefit from treatment with opioid medications.
The researchers noted that the BPAT explained no more than one-third of the variation in pain scores. Future studies could assess other potential pain behaviours — although even these are unlikely to fully capture the “multidimensional experience” of pain.
“The BPAT was found to be reliable and valid for use in critically ill patients unable to self-report,” the authors concluded. “Valid behavioural pain scales are necessary to ensure appropriate assessment of pain and to guide decisions for pain management in this vulnerable population.”
The researchers call for further studies to evaluate how the BPAT is implemented in clinical practice and how it affects pain management and pain outcomes in the ICU.