Behavioural Pain Assessment Tools Research Articles

Nurses’ assessment and management practices of pain among intensive care patients in King Khalid Hospital, Kharj, Riyadh

BackgroundPain is a disagreeable combination of sensory and emotional sensations. Employing behavioral pain assessment tools is strongly associated with improved identification of pain. PurposeThe main purpose of the study is to investigate Nurses’ Assessment and Management Practices of Pain among Intensive Care Patients in King Khalid Hospital, Kharj, Riyadh. Materials and methodsA self-administered questionnaire was employed in a descriptive cross-sectional study. The study focused on nurses employed in the intensive care unit at King Khalid Hospital in Al-Kharj Province. The researchers utilized convenience sampling to recruit participants. Out of the total 48 nurses approached 45 of them provided responses, leading to a response rate of 94%. The Critically Ill questionnaire was utilized to gather information regarding the treatment and evaluation of pain in patients who were in critical condition. Descriptive statistics and inferential statistics were employed to analyze the collected data. Principal resultsit was found that 88% of them utilized instruments to evaluate pain in patients who could express themselves. Among these instruments, the numeric rating scale was the most commonly employed. Furthermore, 77% of the nurses (35 in total) used a pain assessment tool for patients who were unable to communicate, with the Adult Nonverbal Pain Scale being the most frequently used tool in this case. The nurses' perception of the significance of pain assessment was positively associated with the regular utilization of pain assessment tools. Additionally, the nurses considered the use of pain assessment tools with patients who could communicate as more important compared to using such tools with patients who could not communicate. ConclusionsMost ICU nurses utilized nurses' pain assessment instruments to assess the discomfort levels of both patients who could communicate and those who couldn't express themselves effectively. By employing such tools, nurses can improve patient outcomes, ensure effective pain management, and demonstrate a high standard of professional care.

Commentary: Pediatric Pain Measurement, Assessment, and Evaluation

Renee C.B. Manworren, Jennifer Stinson Seminars in Pediatric Neurology Volume 23, Issue 3, August 2016, Pages 189-200 Assessment provides the foundation for diagnosis, selection of treatments, and evaluation of treatment effectiveness for pediatric patients with acute, recurrent, and chronic pain. Extensive research has resulted in the availability of a number of valid, reliable, and recommended tools for assessing children's pain. Yet, evidence suggests children's pain is still not optimally measured or treated. In this article, we provide an overview of pain evaluation for premature neonates to adolescents. The difference between pain assessment and measurement is highlighted; and the key steps to follow are identified. Information about self report and behavioral pain assessment tools appropriate for children are provided; and fac tors to be considered when choosing a specific 1 are outlined. Finally, we preview future approaches to personalized pain medicine in pediatrics that include harnessing the use of potential digital health technologies and genomics.

Pain Control and Sedation in Neuro Intensive Critical Unit

Neurocritical patients who can self-report pain use the 0-10 numerical rating scale (NRS, verbal or visual form). However, critically ill patients whose nervous systems cannot express pain use the behavioral pain scale (BPS) and the critical care pain observation tool (CPOT) behavioral pain assessment tools. These tools reveal pain-related changes in movement, facial expression, posture, and physiological indicators such as heart rate, blood pressure, and respiratory rate. In pain control, it is first essential to reduce unnecessary painkillers through non-drug therapy and maximize the effect of the administered analgesics. For nonneuropathic pain, narcotic analgesics such as fentanyl, hydromorphone, morphine, and remifentanil are administered intravenously. Gabapentin, pregabalin, and carbamazepine are recommended along with narcotic analgesics for neuropathic pain control. In addition, nonnarcotic analgesics for multi-modal analgesia are used to reduce the use of narcotic analgesics or the side effects of narcotic analgesics. In the intensive care unit (ICU), the sedation-agitation scale (SAS) and the Richmond agitation-sedation scale (RASS) are used to determine the depth of sedation to be maintained during shallow or deep sedation, considering the condition of the critically ill patient. When selecting sedatives for critically ill patients, preferentially consider nonbenzodiazepines such as propofol or dexmedetomidine rather than benzodiazepines such as midazolam or lorazepam. In addition, patients use painkillers or sedatives for over a week, and neurological changes or physiological dependence may occur. Therefore, clinicians should evaluate the critically ill patient’s condition, and sedatives and painkillers should be reduced or discontinued.

Levels of pain assessment tools for pediatric dental patients: a narrative review

Pain is defined as an unpleasant sensory and emotional experience associated with actual and potential tissue damage. Pain perception in children causes a number of changes in their emotional state. It can lead to emotions like fear, anxiety, sadness and might have an impact on day-to-day activities. Due to the lack of cognitive development young children are unable to express their pain verbally. Pain assessment can be carried out by using various approaches, such as self-reporting pain assessment tools, behavioural pain assessment tools and by assessment of various physiologic parameters. The process of pain evaluation for a child is strenuous as they have limited cognitive sophistication to describe their painful experiences during any disease process. Out of all the scales discussed, Wong-Bakers facial pain rating scale (WB-FPS) is considered the best as it is simple to use for the operator and can be easily reproduced and can be used in children as young as 3 years of age.

Pain and distress in people with severe or profound ID in Victoria, Australia: Utility of behavioural assessment tools

Pain is often unrecognised and untreated in people with ID. In the absence of self-report, the use of structured behavioural pain assessment tools is best practice for identifying pain in this group. The aim of this research was to explore the utility of the Abbey Pain Scale and The Distress and Discomfort Assessment Tool (DisDAT) for use by residential support workers and family members of adults with severe or profound ID who live in group home settings. Participants were 17 residential support workers and six family members and provided information about 23 adults with severe or profound ID. Participants completed one of the two tools every 2 weeks for 3 months and indicated whether they thought the individual was content, distressed or experiencing pain. In total, 131 completed tools were returned (80 Abbey Pain Scales and 51 DisDATs). The results indicated that higher total pain scores on the Abbey Pain Scale appear to correspond to a report of pain or distress. A range of behaviours from the Abbey Pain Scale were reported to be present when the individuals with ID were reported to be in pain, such as vocalisations and facial expressions, but these and other behaviours were also observed when the individual was reported to be distressed. Similarly, using the DisDAT, there were behaviours that were present when individuals were reported to be experiencing pain which, for the most part, were also reported when individuals were reported to be distressed. Although neither of the tools appeared to distinguish between pain and distress, it is evident that both tools have utility in the assessment of distress. This is a promising finding as it may be that the tools can be used to signal that an individual with severe or profound ID is distressed and that pain is a factor to be considered.

Abstract 9346: Results of a Randomized Study to Understand the Patient Experience of Pain and Satisfaction During Cardiac Catheterization Using an Interval of Time

Background: Research on the patient experience during cardiac catheterization is lacking. Opportunity exists to improve the delivery of procedural sedation to positively impact patient’s report of pain, comfort and satisfaction. We aim to evaluate if the time interval between procedural sedation and subcutaneous lidocaine influences patient experience. Methods: We conducted a prospective, randomized controlled study to determine the effect of 2 time intervals ( < 6 minutes vs > 7 minutes) on 1) total medication dosage, 2) patient-reported and observed pain and 3) patient satisfaction in 175 adults undergoing elective, outpatient cardiac cath from December 2020 to April 2021. Patient reported pain and satisfaction were assessed using the Procedural Sedation Assessment Survey. Observed pain was assessed using the Behavioral Pain Assessment Tool. Generalized linear mixed models were used to analyze the effect of time interval on total medication dose, pain and satisfaction. Results: Of 175 patients randomized, 9 were excluded and 5 withdrew. In the final sample (n=161), the mean age was 62 (SD 13.4), a majority were male (106, 66%), white (117, 74%), with a mean BMI of 28.5 (SD 5.6). Total procedural sedation did not differ between groups. Likewise, patient-reported pain and satisfaction and observed measures of pain did not differ, even after adjustment for age, sex, race, BMI, fellow involvement, vascular access and procedure type. A 3-way interaction was found between procedure type, group assignment, and reported pain during the procedure (p=0.03). Patients undergoing PCI, with intervals < 6 minutes self-reported more intra-procedural pain, despite post hoc analysis showing patients undergoing PCI had higher total medication dosages of both fentanyl and midazolam (p<0.001 & p<0.001) in both groups. Conclusions: No differences were found between groups related to total medication dose, pain or satisfaction regardless of timing between sedation and lidocaine. However, the findings suggest that longer intervals may reduce reported pain among patients undergoing PCI. Further investigation of sedation timing during PCI is needed to potentially improve the patient experience.

Clinical Utility of the Behavioral Pain Assessment Tool in Patients Admitted in the Intensive Care Unit.

IntroductionUnnoticed 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 objectivesThe 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 methodsFollowing 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.ResultsHigh 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.ConclusionThe 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 significanceWe recommend implementing BPAT in the clinical practice for better pain assessment and control in ICU patients.How to cite this articleMitra S, Jain K, Singh J, Saxena P, Nyima T, Selvam SR, et al. 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.

R7 Perceptions of Behavioral Pain Assessment Tools and Pain Outcomes in Non-verbal Patients: A Pilot Survey

R7 Perceptions of Behavioral Pain Assessment Tools and Pain Outcomes in Non-verbal Patients: A Pilot Survey

A Psychometric Analysis Update of Behavioral Pain Assessment Tools for Noncommunicative, Critically Ill Adults.

This is an updated, comprehensive review of the psychometric properties of behavioral pain assessment tools for use with noncommunicative, critically ill adults. Articles were searched in 5 health databases. A total of 106 articles were analyzed, including 54 recently published papers. Nine behavioral pain assessment tools developed for noncommunicative critically ill adults and 4 tools developed for other non-communicative populations were included. The scale development process, reliability, validity, feasibility, and clinical utility were analyzed using a 0 to 20 scoring system, and quality of evidence was also evaluated. The Behavioral Pain Scale, the Behavioral Pain Scale-Nonintubated, and the Critical-Care Pain Observation Tool remain the tools with the strongest psychometric properties, with validation testing having been conducted in multiple countries and various languages. Other tools may be good alternatives, but additional research on them is necessary.

Evaluation of Observational and Behavioural Pain Assessment Tools in Nonverbal Intubated Critically Adult Patients after Open - Heart Surgery: A Systematic Review.

BACKGROUND:Over 70% of patients hospitalised in an intensive care unit (ICU) often experience moderate to severe pain due to pre-existing diseases, trauma, surgery, aggressive procedures, and routine ICU care. Many patients hospitalised in ICU are not able to speak and express their pain due to various causes, including mechanical ventilation, reduced consciousness, and administration of sedative drugs. Therefore, the use of observational and behavioural pain tools is recommended in this group of patients given their inability to express pain.AIM:To examine the existing observational and behavioural tools for assessment of in Nonverbal Intubated Critically Adult Patients after Open-Heart Surgery.METHODS:A systematic review of available observational and behavioural tools for assessment of pain was undertaken using the COSMIN checklist. A literature search was conducted using the following databases: Ovid, Science Direct, Scopus, PubMed, and CINHAL databases, Google Scholar search engine as well as Persian resources Sid, Magiran, Iran doc, and IranMedex up to the end of 2017 were reviewed.RESULTS:A total of 47 studies that had examined five tools used in intensive care units after cardiac surgery in patients under mechanical ventilation were reviewed. Each of the five tools included behavioural and observational items, and only one tool had physiological items. All the tools had been evaluated regarding validity and reliability. In the three tools, sensitivity, specificity, responsiveness, and satisfaction were considered.CONCLUSION:Based on available evidence and investigations, CPOT and BPS tools have good validity and reliability to be used in pain assessment in Nonverbal Intubated Critically Adult Patients after Open-Heart Surgery. The NVPS tool requires more studies to be further confirmed before the assessment of pain in this group of patients.

Study of the effects of hydromorphone on emergence agitation of children anesthetized by sevoflurane

Objective: To observe the effect of hydromorphone on emergence agitation of children anesthetized by Sevoflurane. Methods: One hundred patients without any analgetic, aged 3 to 7 years, ASA Ⅰ-Ⅱ, undergoing strabismus surgery in Beijing Tongren Hospital from March, 2017 to December, 2017 were selected and they were randomly divided into two groups(n=50), H group and F group by random number table. After standardized tidal volume method induction by 8% sevoflurane and oxygen, suiltable laryngeal mask was inserted, and each patient was left spontaneously breathing anesthetized by 2.5%-3.0% sevoflurane.Ten minutes before the surgery, patients in H group were administered a dose of 0.01 mg/kg hydromorphone (diluted to 5 ml with normal saline) by pump control injection in 10 min, whereas patients in F group administered a dose of 1 μg/kg fentanyl in the same way. After the surgery , the patient was sent to postanesthesia care unit. A nurse who was blinded measured the vital signs, pediatric anesthesia emergence delirium(PAED) score, face legs activity cry consolability behavioral pain assessment tool(FLACC) score, the time of opening the eyes and departing from postanesthesia care unit(PACU), and the occurence rates of hypoxemia, swirl or nausea, drowsiness, and other scores. Results: The incidence of emergence agitation(EA) in H group was lower than in F group, whether EA was defined as PAED>10 (18.0% vs 28.0%, P>0.05) or PAED>12(12.0% vs 24.0%, P>0.05), there were not significant differences between them. The ratio of patients whose PAED>15 in F group was 12.0%, while the ratio of H group was 0, there was significant difference between the two groups(P=0.027). The occurrence rates of swirl, glossocoma in H group were 0 and 10.0% while those of F group were all 6.0%, there were no significant differences between the two groups(P>0.05). Conclusions: Comparing with fentanyl, hydromorphone can prevent the occurrence rate of EA of the children anesthetized by sevoflurane equally, even decrease the occurrence rate of the severe EA more observably, and reduce postoperation pain more significantly with less occurrence rate of swirl or nausea. Glossocoma need be paid attention to when HM is administered.

Comparison of Self-Reported and Behavioral Pain Assessment Tools in Critically Ill Patients.

Self-reported and behavioral pain assessment scales are often used interchangeably in critically ill patients due to fluctuations in mental status. The correlation between scales is not well elucidated. The purpose of this study was to describe the correlation between self-reported and behavioral pain scores in critically ill patients. Pain was assessed using behavioral and self-reported pain assessment tools. Behavioral pain tools included Critical Care Pain Observation Tool (CPOT) and Behavioral Pain Scale (BPS). Self-reported pain tools included Numeric Rating Scale (NRS) and Wong-Baker Faces Pain Scales. Delirium was assessed using the confusion assessment method for the intensive care unit. Patient preference regarding pain assessment method was queried. Correlation between scores was evaluated. A total of 115 patients were included: 67 patients were nondelirious and 48 patients were delirious. The overall correlation between self-reported (NRS) and behavioral (CPOT) pain scales was poor (0.30, P = .018). In patients without delirium, a strong correlation was found between the 2 behavioral pain scales (0.94, P < .0001) and 2 self-reported pain scales (0.77, P < .0001). Self-reported pain scale (NRS) and behavioral pain scale (CPOT) were poorly correlated with each other (0.28, P = .021). In patients with delirium, there was a strong correlation between behavioral pain scales (0.86, P < .0001) and a moderate correlation between self-reported pain scales (0.69, P < .0001). There was no apparent correlation between self-reported (NRS) and behavioral pain scales (CPOT) in patients with delirium (0.23, P = .12). Most participants preferred self-reported pain assessment. Self-reported pain scales and behavioral pain scales cannot be used interchangeably. Current validated behavioral pain scales may not accurately reflect self-reported pain in critically ill patients.

The revised-Face, Leg, Activity, Cry, and Consolability scale: an Egyptian version

Background Children with cerebral palsy lack the luxury of self-reporting their pain postoperatively. The revised FLACC (Face, Leg, Activity, Cry, and Consolability) pain scale is a behavioral pain assessment tool that is universally accepted for use in children with cognitive dysfunction. Objective The aim of this study was to cross-culturally adapt and evaluate the validity and reliability of the Egyptian version of the revised FLACC (r-FLACC) scale for use in postoperative pain assessment in children with cerebral palsy. Patients and methods The study was carried out in Ain Shams University Pediatric Hospital on 30 children with cerebral palsy aged 3–12 years scheduled for open Nissen fundoplication. Pain was assessed at baseline, on arrival to postanesthesia care unit, and 30 min after administration of analgesia using the r-FLACC scale (by two independent caregivers) and the visual analog scale (by the child’s parent). Results The r-FLACC scores increased postoperatively and decreased after administration of analgesia (P Moderate to significant correlations between observers for total r-FLACC scores (P Conclusion The Egyptian version of the r-FLACC scale is a valid and reliable tool for postoperative pain assessment in Egyptian children with cerebral palsy.

Pain Assessment and Treatment in Children With Significant Impairment of the Central Nervous System.

Pain is a frequent and significant problem for children with impairment of the central nervous system, with the highest frequency and severity occurring in children with the greatest impairment. Despite the significance of the problem, this population remains vulnerable to underrecognition and undertreatment of pain. Barriers to treatment may include uncertainty in identifying pain along with limited experience and fear with the use of medications for pain treatment. Behavioral pain-assessment tools are reviewed in this clinical report, along with other strategies for monitoring pain after an intervention. Sources of pain in this population include acute-onset pain attributable to tissue injury or inflammation resulting in nociceptive pain, with pain then expected to resolve after treatment directed at the source. Other sources can result in chronic intermittent pain that, for many, occurs on a weekly to daily basis, commonly attributed to gastroesophageal reflux, spasticity, and hip subluxation. Most challenging are pain sources attributable to the impaired central nervous system, requiring empirical medication trials directed at causes that cannot be identified by diagnostic tests, such as central neuropathic pain. Interventions reviewed include integrative therapies and medications, such as gabapentinoids, tricyclic antidepressants, α-agonists, and opioids. This clinical report aims to address, with evidence-based guidance, the inherent challenges with the goal to improve comfort throughout life in this vulnerable group of children.

Pain Measurement in Mechanically Ventilated Patients After Cardiac Surgery: Comparison of the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT)

The Behavioral Pain Scale (BPS) and Critical-Care Pain Observation Tool (CPOT) are behavioral pain assessment tools for sedated and unconscious critically ill patients. The aim of this study was to compare the reliability, internal consistency, and discriminant validation of the BPS and the CPOT simultaneously in mechanically ventilated patients after cardiac surgery. A prospective, observational cohort study. A 20-bed closed-format intensive care unit with mixed medical, surgical, and cardiac surgery patients in a teaching hospital in Amsterdam, The Netherlands. The study comprised 72 consecutive intubated and mechanically ventilated patients after cardiac surgery who were not able to self-report pain. Two nurses assessed the BPS and CPOT simultaneously and independently at the following 4 moments: rest, a nonpainful procedure (oral care), rest, and a painful procedure (turning). Both scores showed a significant increase of 2 points between rest and turning. The median BPS score of nurse 1 showed a significant increase of 1 point between rest and the nonpainful procedure (oral care), whereas both median CPOT scores did not change. The interrater reliability of the BPS and CPOT showed fair-to-good agreement of 0.74 overall. During the periods of rest 1 and rest 2, values ranged from 0.24 to 0.46. Cronbach's alpha values for the BPS were 0.62 (nurse 1) and 0.59 (nurse 2) compared with 0.65 and 0.58, respectively, for the CPOT. The BPS and CPOT are reliable and valid pain assessment tools in a daily clinical setting. However, the discriminant validation of both scores seems less satisfactory in sedated or agitated patients and this topic requires further investigation.

Pain Assessment in INTensive care (PAINT): an observational study of physician-documented pain assessment in 45 intensive care units in the United Kingdom.

SummaryPain is a common and distressing symptom experienced by intensive care patients. Assessing pain in this environment is challenging, and published guidelines have been inconsistently implemented. The Pain Assessment in INTensive care (PAINT) study aimed to evaluate the frequency and type of physician pain assessments with respect to published guidelines. This observational service evaluation considered all pain and analgesia‐related entries in patients’ records over a 24‐h period, in 45 adult intensive care units (ICUs) in London and the South‐East of England. Data were collected from 750 patients, reflecting the practice of 362 physicians. Nearly two‐thirds of patients (n = 475, 64.5%, 95%CI 60.9–67.8%) received no physician‐documented pain assessment during the 24‐h study period. Just under one‐third (n = 215, 28.6%, 95%CI 25.5–32.0%) received no nursing‐documented pain assessment, and over one‐fifth (n = 159, 21.2%, 95%CI 19.2–23.4)% received neither a doctor nor a nursing pain assessment. Two of the 45 ICUs used validated behavioural pain assessment tools. The likelihood of receiving a physician pain assessment was affected by the following factors: the number of nursing assessments performed; whether the patient was admitted as a surgical patient; the presence of tracheal tube or tracheostomy; and the length of stay in ICU. Physician‐documented pain assessments in the majority of participating ICUs were infrequent and did not utilise recommended behavioural pain assessment tools. Further research to identify factors influencing physician pain assessment behaviour in ICU, such as human factors or cultural attitudes, is urgently needed.

Current Use of Pain Scores in Dutch Intensive Care Units: A Postal Survey in the Netherlands.

Pain is a common problem for critically ill patients treated in the intensive care unit (ICU) and can have serious consequences. For this reason, the appropriate recognition and treatment of pain is of extreme importance. However, pain assessment in critically ill patients can be challenging because these patients are often unable to self-report. To identify attitudes and practices regarding the assessment and management of pain in ICU patients unable to self-report, we surveyed all adult ICUs in the Netherlands. A multicenter, exploratory survey was sent by mail to all adult ICUs in the Netherlands. Eighty-four of 107 ICUs returned the questionnaire for a response rate of 79%. In patients able to self-report, 94% (n = 79; 95% confidence interval [CI], 86.7%-98%) of the ICUs used a standardized pain score. Visual Analog Scale and Numerical Rating Scale were used in 57% (n = 48; 99.3% CI, 41%-72%) and 48% (n = 40; 99.3% CI, 33%-64%), respectively. Nonteaching hospitals used pain assessment tools more often than teaching hospitals (P = 0.012). In patients not able to self-report, pain assessment tools were used in 19% (n = 16) of the ICUs. In the ICUs that used behaviorally based scoring systems, the Critical Care Pain Observation Tool and Behavioral Pain Scale (BPS) were used in 6% (n = 5; 99.5% CI, 1.1%-17%) and 5% (n = 4; 99.5% CI, 0.1%-15%), respectively. Among Dutch nurses, nursing opinion was considered the gold standard assessment in 36% (n = 30; 98.8% CI, 23%-50%) of the respondents, even when a patient was able to self-report and pain scales were used. In patients unable to self-report, nurses judged themselves to be more accurate than a behavioral pain assessment tool in 98% (n = 82; 98.8% CI, 89.7%-99.9%) of the patients. In the Netherlands, most ICUs used a standardized pain score in patients able to self-report. Nonteaching hospitals used pain assessment tools more often than teaching hospitals. In patients unable to self-report, pain is not routinely measured with a validated behavioral pain assessment tool. Almost all nurses in our survey felt that their assessment of patient pain was more accurate than behavioral pain assessment tools in patients unable to self-report. More research is needed to identify factors preventing more widespread acceptance of validated behavioral pain scores in patients unable to self-report.

An evaluation of instruments for identifying acute pain among hospitalized pediatric patients: a systematic review protocol.

REVIEW QUESTION / OBJECTIVE The objectives of the review are to evaluate evidence on: 1) the accuracy of self-report pain assessment tools; 2) the accuracy of a bundled approach (combined self-report and behavioral/observational pain assessment tools) in identifying acute pain intensity among hospitalized pediatric patients between the ages of six and 15 years. More specifically, the review question is: Is a bundled self-report and behavioral pain assessment tool more accurate in identifying acute pain intensity among hospitalized children aged six to 15 years of age compared to a self-report pain assessment tool? INCLUSION CRITERIA Types of participants This review will consider studies that include pediatric patients with acute pain, hospitalized between the ages of six and 15 years. Exclusions include children with chronic pain, Intensive Care Unit patients who are sedated or intubated, and patients being treated for pain with cancer. Studies will be excluded if the focus is on children with developmental delays, infants or children experiencing chronic pain or pain associated with cancer, neonatal patients and adult patients. Types of intervention(s)/phenomena of interest This review will consider studies that evaluate acute pain in hospitalized children utilizing self-report pain assessment tools compared to a combination of behavioral/observational pain assessment tools, and self-report tools. Types of outcomes This review will consider studies that include the following outcome measures: presence or absence of pain, pain intensity rating (measured by a score on a self-report tool by self or by proxy), analgesic use as measured by type, dosage and frequency of administration, TRUNCATED AT 250 WORDS

Assessment and management of acute pain in the older person with cognitive impairment: A qualitative study

IntroductionOlder Australians experience health disparities in pain management compared to other groups. This article is focused on understanding the emergency nurses' perceptions of pain and pain management for older persons with cognitive impairment and presenting with a long bone fracture. This article is part of a larger study focusing on emergency nurses' pain management practices for older Australians with cognitive impairment. AimThe aim of the study was to understand emergency nurses' perceptions of the management of pain for older persons with cognitive impairment and presenting with a long bone fracture. MethodThis is part of a larger multicentre programme of research exploring pain management in older persons with cognitive impairment and who are experiencing pain from a long bone fracture. This study had a qualitative research design, with data collected through focus group interviews and a thematic method of analysis. The study is framed by a constructivist's paradigm, which enabled multiple realities to surface and be interpreted. ResultsEighty emergency nurses participated, with 67 (84%) females and 13 (16%) males, in 16 focus groups across four emergency departments. Nurses had an average of 12.5 years as a Registered Nurse (SD ± 10.06) and 8.6 years (SD ± 8.64) emergency experience. Five themes emerged from data analysis and included: 1) Belief in championing pain management; 2) Pain management and the ageing processes; 3) Lack of pain assessment tools for the cognitively impaired older person; 4) Delivering analgesia – a balancing act; and 5) Policy barriers to nurse initiated pain management. ConclusionThis study makes clear the challenges clinicians' face in managing pain in older patients presenting to emergency departments. More specifically, older persons with cognitive impairment face substantially greater obstacles in receiving effective pain relief given the lack of any standardised pain assessment screening tool within emergency departments. To improve pain management practices emergency clinicians need to test the utility of behavioural pain assessment tools for cognitively impaired older persons within the emergency context.

Pain measurement in mechanically ventilated critically ill patients: Behavioral Pain Scale versus Critical-Care Pain Observation Tool

PurposeThe Behavioral Pain Scale (BPS) and Critical-Care Pain Observation Tool (CPOT) are behavioral pain assessment tools for uncommunicative and sedated intensive care unit (ICU) patients. This study compares the discriminant validation and reliability of the CPOT and the BPS, simultaneously, in mechanically ventilated patients on a mixed-adult ICU. Materials and methodsThis is a prospective observational cohort study in 68 mechanically ventilated medical ICU patients who were unable to report pain. ResultsThe BPS and CPOT scores showed a significant increase of 2 points between rest and the painful procedure (turning). The median BPS scores between rest and the nonpainful procedure (oral care) showed a significant increase of 1 point, whereas the median CPOT score remained unchanged. The interrater reliability of the BPS and CPOT scores showed a fair to good agreement (0.74 and 0.75, respectively). ConclusionsThis study showed that the BPS and the CPOT are reliable and valid for use in a daily clinical setting. Although both scores increased with a presumed painful stimulus, the discriminant validation of the BPS use was less supported because it increased during a nonpainful stimulus. The CPOT appears preferable in this particular group of patients, especially with regard to its discriminant validation.