Psychometric Properties of the Behavioral Pain Scale in Traumatic Brain Injury

Nurses’ Evaluations of the Feasibility and Clinical Utility of the Use of the Critical-Care Pain Observation Tool-Neuro in Critically Ill Brain-Injured Patients

“…Specifically developed for ICU patients unable to self-report, the Behavioral Pain Scale or BPS (Payen et al, 2001) and the Critical-Care Pain Observation Tool (CPOT) by Gélinas, Fillion, Puntillo, Viens, & Fortier (2006) were tested in brain-injured ICU patients . A low effect size was found for the facial expression item of the BPS (Ribeiro et al, 2019) and a grimace score of 2 and muscle rigidity score of 2 on the CPOT were not frequently observed (Joffe, McNulty, Boitor, Marsh, & Gélinas, 2016) raising attention about suitability of these items in this specific ICU population. In alignment with these findings, recent evidence has shown that braininjured ICU patients express unique behaviors (Arbour et al, 2014;Roulin & Ramelet, 2014), and guidelines highlighted the need to revise behavioral pain scales to make their content more suitable to these patients (Barr et al, 2013;Devlin et al, 2018).…”

Analgesia in the Neurosurgical Intensive Care Unit

“…In another study, Ribeiro and coworkers have studied psychometric properties of the BPS in traumatic brain injury. They found that BPS had good internal consistency, good discriminant validity, moderate to excellent reliability, and high responsiveness, but also that deep sedation affected the increase of grading during painful procedures (24).…”

“…Currently, none of the above rating scales can be considered the gold standard for pain assessment in neurocritical patients. As with other ICU patients, pain should be routinely assessed using validated behavioral scales and documented, especially before invasive procedures and physical therapy (24).…”

Behavioral and Physiological Pain Responses in Brain-Injured Patients Who Are Unable to Communicate in the Intensive Care Unit

“…The recent clinical practice guidelines from the Society of Critical Care Medicine (2018) recommend the use of the Behavioral Pain Scale (BPS; Payen et al, 2001) and the Critical-care Pain Observation Tool (CPOT;G elinas et al, 2006) to assess pain for nonverbal patients, considering reliability, validity, and feasibility (Devlin et al, 2018). Accordingly, the validity of BPS (Dehghani et al, 2014;Ribeiro et al, 2019) and CPOT (Joffe et al, 2016;Sulla et al, 2017) has been examined in brain-injured patients. Their discriminative validities were supported by observing the total scores on both scales during nociceptive procedures compared with non-nociceptive procedures.…”

“…Their discriminative validities were supported by observing the total scores on both scales during nociceptive procedures compared with non-nociceptive procedures. Specific behavioral pain indicators (e.g., facial expression and muscle tension) are less observed in brain-injured patients (Joffe et al, 2016;Ribeiro et al, 2019) compared with other nonverbal patients (Chanques et al, 2009;Payen et al, 2001). Additionally, unlike in nonebraininjured patients, atypical behavioral pain responses such as flushing and sudden eye opening were observed in brain-injured patients according to the patient's level of consciousness (Arbour, et al, 2014b;G elinas et al, 2019).…”