(354) Development of a pain assessment scale for patients with moderate to severe brain injury: A pilot study

Abstract

Evaluation of pain in traumatic brain injury (TBI) patients with impaired cognition and communicative ability is confounded by the absence of reliable self-reporting of symptoms. Many studies have looked at pain behaviors in the confused elderly, cognitively impaired, neonatal and mild TBI (mTBI) populations, yet there have been no formal validation of methods to assess pain behavior in the moderate to severe TBI (sTBI) population. We sought to develop a method of quantifying pain levels (Behavioral Pain Scale, BPS) based on pain behaviors observed in patients with brain injuries. The study took place at an urban academic rehabilitation hospital. There were 18 nonverbal patients with varying degrees of TBI brain injury: Rancho los Amigos Scale (RAS) and Reverse Wong Baker (RWB) scale scores ranged between II-IV and 0-6, respectively. Patients were monitored for fifteen minutes by blinded and unblinded observers who rated specific behaviors. Pain behaviors were grouped into three categories: vocalization, facial behaviors, and body behaviors, all contributing to the patient’s total BPS score. The most frequently observed behaviors were limb movement (83%), facial grimacing (67%), spasms/contractures (50%), and extended eye closing (37.5%). The BPS scores correlated significantly with the RWB (rs = .590 , p = .01), but not with the RAS (p = .877) or the Glasgow scores (p = .193). Injury etiology and pain behaviors do not appear to be associated; however statistical examination with a larger sample size may prove otherwise. Preliminary development of a Behavioral Pain Score in nonverbal TBI patients shows a correlation with RWB, but not with the RAS or Glasgow scores. Further validation is warranted. Evaluation of pain in traumatic brain injury (TBI) patients with impaired cognition and communicative ability is confounded by the absence of reliable self-reporting of symptoms. Many studies have looked at pain behaviors in the confused elderly, cognitively impaired, neonatal and mild TBI (mTBI) populations, yet there have been no formal validation of methods to assess pain behavior in the moderate to severe TBI (sTBI) population. We sought to develop a method of quantifying pain levels (Behavioral Pain Scale, BPS) based on pain behaviors observed in patients with brain injuries. The study took place at an urban academic rehabilitation hospital. There were 18 nonverbal patients with varying degrees of TBI brain injury: Rancho los Amigos Scale (RAS) and Reverse Wong Baker (RWB) scale scores ranged between II-IV and 0-6, respectively. Patients were monitored for fifteen minutes by blinded and unblinded observers who rated specific behaviors. Pain behaviors were grouped into three categories: vocalization, facial behaviors, and body behaviors, all contributing to the patient’s total BPS score. The most frequently observed behaviors were limb movement (83%), facial grimacing (67%), spasms/contractures (50%), and extended eye closing (37.5%). The BPS scores correlated significantly with the RWB (rs = .590 , p = .01), but not with the RAS (p = .877) or the Glasgow scores (p = .193). Injury etiology and pain behaviors do not appear to be associated; however statistical examination with a larger sample size may prove otherwise. Preliminary development of a Behavioral Pain Score in nonverbal TBI patients shows a correlation with RWB, but not with the RAS or Glasgow scores. Further validation is warranted.