Current Use of Pain Scores in Dutch Intensive Care Units

Abstract

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.

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

“…Internationally, widespread failure of the adoption of frequent validated pain assessments by nurses has been reported 17, 18, despite the publication of the ACCM guidelines 14. Our data replicate these findings in a large sample of UK ICUs.…”

“…We recruited ICUs within a specific geographical region, many of which engage in regular audit and research. It is, therefore, unclear how generalisable these results are to practice elsewhere; however, evidence from nursing literature shows that pain is managed poorly in ICUs in many countries 17, 18. This study did not address procedural pain; a recent trial of the management of procedural pain highlighted unacceptably high baseline pain scores, suggesting that there was a need to control background pain before adequate procedural pain therapy can be attempted 27.…”

“…Recent work by Van der Woude et al 18 highlighted the belief among nurses that subjective nursing assessment of pain is superior to validated scales, despite evidence to the contrary 26.…”

“…The American College of Critical Care Medicine (ACCM) 14 has emphasised the need for regular pain assessment along with the use of validated tools, such as the critical care pain observational tool (CPOT) 15, and the behavioural pain scale (BPS) 16. Despite their dissemination, recent surveys indicate limited use among nursing staff 17, 18. To date, there are no observational data regarding physician pain assessment practice.…”

Acute chest pain intensity in a cardiopulmonary emergency unit

“…So, analgesic therapy should be flexible to always reach patients' analgesia and comfort. For being unspecific, acute chest pain may be related or not to coronary disease and VAS is used to measure pain intensity and to tailor analgesic therapy; however, there are limitations with regard to the involvement of different affective and cultural variables and to multiple dimensions involved with pain, which makes the search for biochemical pain markers a relevant option 17 . A study has evaluated coronary calcium score to rule out the possibility of acute coronary syndrome and has shown that this is a good alternative to rule out most cases of coronary disease; however, it is mandatory tha such information are compared to others, such as clinical evaluation and patient's history 18 .…”