Assessing pain behaviors in healthy subjects using the Critical-Care Pain Observation Tool (CPOT): a pilot study

Tousignant-Laflamme, Yannick; Bourgault, Patricia; Gélinas, Claude; Daigle, Kathya

doi:10.1016/j.jpain.2009.01.008

Cited by 4 publications

(3 citation statements)

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“…Importantly, when discussing the status of the central nervous system, 2 validated scoring tools are already reported, the Critical Care Pain Observation Tool (CPOT) score and the Confusion Assessment Method (CAM-ICU) score for delirium. 21,22 Inclusion of Richards Campbell Sleep Score from the proceeding night was thought to provide an opportunity to systematically bring forth sleep quality concerns. This would provide opportunity for an earlier decrease of assessment frequency, and to engage in sleep promotion earlier during ICU admission, specifically addressing concerns voiced by nurses.…”

Section: Methodsmentioning

confidence: 99%

Providing Evidence-Based Care, Day and Night: A Quality Improvement Initiative to Improve Intensive Care Unit Patient Sleep Quality

Douglas

Hobbs

Sibley

et al. 2020

J Intensive Care Med

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Objective: Evidence-based guidelines recommend promoting sleep in the Intensive Care Unit (ICU), yet many patients experience poor sleep quality. We sought to engage allied health staff and patient families to determine barriers to sleep promotion, to measure sleep quality for ICU patients, and to evaluate the improvement in sleep quality after implementation of nursing morning report protocol and a doorway poster. Design: The study followed an interrupted time-series framework of quality improvement. Qualitative diagnostics included focus groups and interviews with patients, families, and allied health care workers, analyzed by qualitative descriptive analysis. Quantitative diagnostics included direct observation of nurses and patients overnight. Analysis of primary outcome data used statistical process control methodology. Patients: Patients included were >18 years old, admitted overnight to a Canadian tertiary academic ICU, with a Richards Agitation Sedation Scale (RASS) ≥−2. Interventions: Sleep quality was measured using the Richards Campbell Sleep Questionnaire (RCSQ). Two interventions were developed: sleep quality in morning nursing report, and a doorway poster. Main results: A total of 2332 patient nights across 7 consecutive months were included for analysis. Baseline sleep in the ICU was poor (mean RCSQ 53.7/100). Root cause-analysis identified the most prominent sleep barriers as nurse stigma associated with less active management of patients and lack of physician engagement. No significant improvement occurred over the sleep quality improvement initiative (mean RCSQ 59.5/100). Sleep quality was better among non-delirious patients compared with delirious patients (mean RCSQ 62.7 vs 53.3). Conclusion: The intervention of a nursing morning report protocol and sleep posters did not improve the quality of ICU patient sleep in this study. Structured interviews revealed potential sleep barriers to be addressed such as nursing stigma and inappropriate awakenings. Nursing stigma has not been previously linked to sleep quality.

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Section: Methodsmentioning

confidence: 99%

Providing Evidence-Based Care, Day and Night: A Quality Improvement Initiative to Improve Intensive Care Unit Patient Sleep Quality

Douglas

Hobbs

Sibley

et al. 2020

J Intensive Care Med

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“…41,42 In a sample of postcardiotomy patients (n ¼ 99), Gélinas and colleagues 43 report maximal psychometric success for identification of pain with a cutoff score greater than 2 during a nociceptive procedure (sensitivity 86% and specificity 78%). More recent studies demonstrate moderate correlation of CPOT scores with self-report in healthy individuals exposed to noxious stimuli 44 and reveal limitations of the CPOT (among other behavioral indicators) in a burn population. 45 Behavioral Pain scale -Non-Intubated.…”

Section: The Noncommunicative Patientmentioning

confidence: 97%

Pain in the ICU

Azzam

Alam

2012

J Intensive Care Med

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Pain is abundant in the intensive care unit (ICU). Successful analgesia demands a comprehensive appreciation for the etiologies of pain, vigilant clinical assessment, and personalized treatments. For the critically ill, frequent threats to mental and bodily integrity magnify the experience of pain, challenging clinicians to respond swiftly and thoughtfully. Because pain is difficult to predict and physiologic correlates are not specific, self-report remains the gold standard assessment. When communication is limited by intubation or cognitive deficits, behavioral pain scales prove useful. Patient-tailored analgesia aspires to mitigate suffering while optimizing alertness and cognitive capacity. Mindfulness of the neuropsychiatric features of pain helps the ICU clinician to clarify limits of traditional analgesia and identify alternative approaches to care. Armed with empirical data and clinical practice recommendations to better conceptualize, identify, and treat pain and its neuropsychiatric comorbidities, the authors (psychiatric consultants, by trade) reinforce holistic approaches to pain management in the ICU. After all, without attempts to understand and relieve suffering on all fronts, pain will remain undertreated.

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“…With normal levels of arterial pressure, baroreceptors are constantly active and exert a continuous inhibition on sympathetic efferent activity. Their activation by increased blood pressure, as occurs during cold pressor test (Mourot, Bouhaddi, & Regnard, 2009;Tousignant-Laflamme, Bourgault, Gelinas,& Marchand, 2010), leads to increased discharge of vagal cardio-inhibitory neurons and decreased discharge of sympathetic neurons controlling the heart and peripheral blood vessels (Kirchheim, 1976;Abboud and Thames, 1983).…”

Section: )mentioning

confidence: 99%

HYPNOTIZABILITY AND PAIN MODULATION: A Body–Mind Perspective

Varanini¹,

Balocchi²,

Carli

et al. 2018

International Journal of Clinical and Experimental Hypnosis

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The study investigated whether the cardiac activity and cognitive-emotional traits sustained by the behavioral inhibition/activation system (BIS/BAS) may contribute to hypnotizability-related pain modulation. Nociceptive stimulation (cold-pressor test) was administered to healthy participants with high (highs) and low (lows) hypnotizability in the presence and absence of suggestions for analgesia. Results showed that heart rate increased abruptly at the beginning of nociceptive stimulation in all participants. Then, only in highs heart rate decreased for the entire duration of hand immersion. During stimulation with suggestions of analgesia, pain threshold negatively correlated with heart rate. BIS/BAS activity partially accounted for the observed hypnotizability-related differences in the relation between cardiac interoception and pain experience.

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Assessing pain behaviors in healthy subjects using the Critical-Care Pain Observation Tool (CPOT): a pilot study

Cited by 4 publications

References 0 publications

Providing Evidence-Based Care, Day and Night: A Quality Improvement Initiative to Improve Intensive Care Unit Patient Sleep Quality

Providing Evidence-Based Care, Day and Night: A Quality Improvement Initiative to Improve Intensive Care Unit Patient Sleep Quality

Pain in the ICU

HYPNOTIZABILITY AND PAIN MODULATION: A Body–Mind Perspective

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