Pain Assessment in Noncommunicative Adult Palliative Care Patients

McGuire, Deborah B.; Kaiser, Karen; Haisfield-Wolfe, Mary Ellen; Iyamu, Florence

doi:10.1016/j.cnur.2016.05.009

Cited by 49 publications

(48 citation statements)

References 60 publications

(108 reference statements)

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“…Pain is an unpleasant subjective and multidimensional experience related to actual or potential tissue damage. [1] Intensive care unit (ICU)-admitted patients experience pain because of the painful interventions and routine daily care procedures. [2] There are barriers to effective verbal communication in these patients such as sedation, decreased level of consciousness, endotracheal intubation, and mechanical ventilation, which are limiting factors for patient's self-report of pain.…”

Section: Introductionmentioning

confidence: 99%

Comparison of two pain scales: Behavioral pain scale and critical-care pain observation tool during invasive and noninvasive procedures in intensive care unit-admitted patients

Gomarverdi

Sedighie

Seifrabiei

et al. 2019

Iranian J Nursing Midwifery Res

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Background: Critically ill patients admitted to intensive care units (ICUs) frequently experience pain, but the severity of pain in this group of patients is underestimated by the treatment team due to barriers to verbal communication. The aim of the present study was comparing the severity of pain measured by two scales: behavioral pain scale (BPS) and critical-care pain observation tool (CPOT) in ICU-admitted patients during routine daily procedures. Materials and Methods: Ninety patients were enrolled in the study. The severity of pain was measured during resting, invasive (suctioning) and noninvasive (mouthwash and body position change) procedures, and respiratory physiotherapy with two scales: BPS and CPOT. Wilcoxon and Friedman statistical tests were used to compare the score of pain in different situations, and Spearman correlation coefficient was also used to measure the correlation of pain score measured by two scales. Results: Patients experienced no pain during resting, mild pain during changing position, and respiratory physiotherapy, mild-to-moderate pain during mouthwash and moderate pain during secretion suctioning. Wilcoxon test used for pairwise comparisons between pain score in different situations showed a significant difference in both scales ( p < 0.05). There were positive and strong correlations ( r > 0.80, p < 0.05) between the pain score measured by BPS and CPOT from ICU-admitted patients in all procedures. Conclusions: Critically ill patients in ICU experience a different range of pain in routine daily care. BPS and CPOT scales could be used successfully for monitoring of pain in this group of patients.

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Section: Introductionmentioning

confidence: 99%

Comparison of two pain scales: Behavioral pain scale and critical-care pain observation tool during invasive and noninvasive procedures in intensive care unit-admitted patients

Gomarverdi

Sedighie

Seifrabiei

et al. 2019

Iranian J Nursing Midwifery Res

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show abstract

“…The BPS and CPOT, unlike BPAT, consist of a confounding factor, i.e., compliance with mechanical ventilation, and complex training is required prior to use. 13 , 18 In BPS, muscle rigidity is assessed visually whereas in CPOT it is tested while moving patients’ arm. 4 , 16 , 23 , 24 The CPOT and BPS also need further evaluation in delirious patients, patients with traumatic brain injury and painful ICU procedures (except positioning and tracheal suctioning), respectively.…”

Section: Discussionmentioning

confidence: 99%

“… 4 , 16 , 23 , 24 The CPOT and BPS also need further evaluation in delirious patients, patients with traumatic brain injury and painful ICU procedures (except positioning and tracheal suctioning), respectively. 13 , 17 , 18 , 25 CPOT- Neuro has been derived from original CPOT for assessing pain in critically ill brain-injured patients. 8 In some studies, validity and reliability of BPS were variable.…”

Section: Discussionmentioning

confidence: 99%

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

Mitra¹,

Jain²,

Singh³

et al. 2020

Indian Journal of Critical Care Medicine

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A bstract Introduction Unnoticed 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 objectives The 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 methods Following 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. Results High 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. Conclusion The 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 significance We recommend implementing BPAT in the clinical practice for better pain assessment and control in ICU patients. How to cite this article Mitra 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.

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“…A recent meta-analysis identified multiple pain assessment tools for patients with dementia, but there was insufficient information on their validity [ 38 ]. Furthermore, several non-verbal pain assessment tools have been developed, although a review concluded these tools do not determine level of pain and further research is needed to test the tools with different patient populations [ 39 ]. Notably, this supplementary analysis highlights that some carers perceive that the patient’s pain is not being assessed, suggesting that healthcare professionals may not be assessing pain in people with dementia or who are non-verbal, or they are not communicating their assessment to carers.…”

Section: Discussionmentioning

confidence: 99%

Symptom management, nutrition and hydration at end-of-life: a qualitative exploration of patients’, carers’ and health professionals’ experiences and further research questions

et al. 2018

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BackgroundSymptom management is an essential aspect of palliative and end-of-life care, but evidence suggests that patients’ symptoms may not always be relieved, causing significant harm to patients and magnifying their relatives’ distress. A growing body of evidence focuses on symptom management at the end-of-life, but research funding for palliative care remains disproportionately low. It is therefore crucial that research funding is targeted at areas of importance to patients and relatives. The Palliative and end-of-life care Priority Setting Partnership (PeolcPSP) undertook a UK-wide free-text survey to establish research priorities within palliative and end-of-life care and disseminated its results in 2015. Much of the data were related more broadly to personal perceptions and experiences rather than specific research questions. The aim of this article is to report on a supplementary analysis exploring the experiences and questions of PeolcPSP survey respondents regarding symptoms, hydration and nutrition.MethodsThe PeolcPSP data (n = 1403) were coded by a team of qualitative researchers in a supplementary analysis. There were 190 responses that related to symptoms, nutrition and hydration. The data were analysed thematically using Braun and Clarke’s approach.ResultsFive themes were identified: pain, breathlessness, agitation, nutrition and hydration. The majority of responses related to symptoms that were sub-optimally managed, in particular pain. Nutrition and hydration were of significant concern, particularly for carers. Overall, respondents consistently asked about the most effective, evidence-based methods for managing symptoms and suggested areas where further research is necessary.ConclusionsThis study highlights the perceptions and experiences of patients, families and professionals within palliative care, highlighting the need for improved care, communication and further research to establish which treatments are most effective within a palliative care population. This is essential to reduce harm and distress for patients and families.Electronic supplementary materialThe online version of this article (10.1186/s12904-018-0314-4) contains supplementary material, which is available to authorized users.

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Pain Assessment in Noncommunicative Adult Palliative Care Patients

Cited by 49 publications

References 60 publications

Comparison of two pain scales: Behavioral pain scale and critical-care pain observation tool during invasive and noninvasive procedures in intensive care unit-admitted patients

Comparison of two pain scales: Behavioral pain scale and critical-care pain observation tool during invasive and noninvasive procedures in intensive care unit-admitted patients

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

Symptom management, nutrition and hydration at end-of-life: a qualitative exploration of patients’, carers’ and health professionals’ experiences and further research questions

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