In this episode, I’ll discuss whether non-verbal ICU pain scales can indicate the severity of pain.
The use of pain assessments for patients who are unable to verbally communicate are recommended in the SCCM Pain, Agitation & Delirium Guidelines.
2 examples of such assessments are the Behavioral Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT).
The Behavioral Pain Scale (BPS) examines 3 domains giving 1 to 4 points on each domain for a range in score of 3 to 12. The 3 domains are:
Movements of upper limbs
Compliance with mechanical ventilation
The Critical Care Pain Observation Tool (CPOT) examines 4 domains giving 0 to 2 points on each domain for a range in score of 0 to 8. The 4 domains are:
Compliance with the ventilator or vocalization if extubated
Because the traditional numerical pain rating scale for pain is used to judge the severity of pain based on how high pain is rated out of a maximum of 10 points, there is a temptation to do the same thing with the BPS and the CPOT. In practice this would mean administering a larger analgesic dose for a BPS of 12 than 5 for example.
In the original BPS trial, there was a non-statistically significant trend between the dose of analgesic and the BPS score in patients who had pain behaviors from nociceptive pain such as suctioning or mobilization.
However, there is a lack of evidence to support using a severity-based dose of analgesic depending on how high any of these behavioral pain scale scores are.
Therefore, I use these scales to determine the presence of pain-related behaviors, but administer a fixed dose of analgesic and then re-assess for pain-related behaviors at an appropriate interval rather than giving higher analgesic doses for higher scores.
Members of my Hospital Pharmacy Academy have access to practical training on the use of pain, sedation, and delirium scales in ICU patients. You can get immediate access to this and hundreds of other trainings and resources to help in your practice at pharmacyjoe.com/academy.
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