Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20190021
Brazilian Journal of Pain
Original Article

Pain assessment in critical patients using the Behavioral Pain Scale

Avaliação da dor em pacientes críticos por meio da Escala Comportamental de Dor

Laudice Santos Oliveira; Maiara Pimentel Macedo; Stefany Ariadley Martins da Silva; Ana Paula de Freitas Oliveira; Victor Santana Santos

http://dx.doi.org/10.5935/2595-0118.20190021 BrJP, vol.2, n2, p.112-116, 2019
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Abstract

BACKGROUND AND OBJECTIVES: The sensation of pain is essential for life, and its assessment in critical non-contacting patients can be performed using validated scales. The Behavioral Pain Scale is a highly accurate tool that has been widely used in this group of patients. This study aimed to describe and characterize pain and the use of analgesia in the emergency or intensive care service.

METHODS: This was a cross-sectional study with a quantitative approach with 67 critically ill patients unable to verbalize their pain perception, who were hospitalized in the emergency service or Intensive Care Units of a public hospital in Vitória da Conquista, Bahia from April to July 2017. Clinical and epidemiological data were collected using the medical record and then applied to the Behavioral Pain Scale for pain assessment.

RESULTS: There was a predominance of male patients (47/70.1%). Three groups were identified based on the use of sedatives and analgesics: patients taking sedatives and analgesics combined, only analgesia, and those without any sedation or analgesia. We observed ascending Behavioral Pain Scale scores in all groups during tracheal suction, but the same did not occur with the physiological parameters.

CONCLUSION: The study proposes the adoption of pain assessment scales in critical patients, such as the Behavioral Pain Scale, as well as the use of protocols for analgesia management, and consequently improve the quality of care and patient's recovery.

Keywords

Emergency medical services, Intensive Care Units, Pain, Pain management, Pain measurement

Resumo

JUSTIFICATIVA E OBJETIVOS: A sensação de dor é essencial para a vida. Sua avaliação em pacientes críticos não contatantes pode ser realizada por meio de escalas validadas. A Behavioral Pain Scale é um instrumento de aplicação, com elevada acurácia, e que tem sido amplamente utilizada neste grupo de pacientes. Este estudo objetivou descrever e caracterizar a dor e o uso de analgesia no serviço de urgência e cuidados intensivos.

MÉTODOS: Trata-se de um estudo transversal com abordagem quantitativa, realizado com 67 pacientes críticos impossibilitados de verbalizar a percepção de dor, os quais estavam hospitalizados na área vermelha do pronto-socorro ou nas Unidades de Terapia Intensiva de um hospital público de referência em Vitória da Conquista, Bahia no período de abril a julho de 2017. Dados clínicos e epidemiológicos foram coletados utilizando-se o prontuário e em seguida foi aplicada a Behavioral Pain Scale para avaliação da dor.

RESULTADOS: Houve predomínio de pacientes do sexo masculino (47/70,1%). Foram identificados três grupos com base no uso de sedativos e analgésicos: pacientes em uso de sedoanalgesia, uso apenas de analgesia, e os que estavam sem sedação ou analgesia. Visualizou-se ascensão dos escores da Behavioral Pain Scale em todos os grupos durante a aspiração traqueal, porém o mesmo não aconteceu com os parâmetros fisiológicos.

CONCLUSÃO: O estudo apresentou como proposta a adoção de escalas de avaliação da dor no paciente crítico, como a Behavioral Pain Scale, bem como uso de protocolos de analgesia e manuseio, melhorando assim a qualidade da assistência prestada e a recuperação do paciente.

Palavras-chave

Dor, Manuseio da dor, Mensuração da dor, Pronto-Socorro, Unidade de Terapia Intensiva

References

Silva JA, Ribeiro-Filho NP. A dor como um problema psicofísico. Rev Dor. 2011;12(2):138-51.

Koppert W. Acute pain therapy in pediatrics and geriatrics - pain assessment and treatment options. Anasthesiol Intensivmed Notfallmed Schmerzther. 2011;46(5):332-3.

Puntillo KA, White C, Morris AB, Perdue ST, Stanik-Hutt J, Thompson CL. Patients' perceptions and responses to procedural pain: results from Thunder Project II. Am J Crit Care. 2001;10(4):238-51.

Puntillo KA, Morris AB, Thompson CL, Stanik-Hutt J, White CA, Wild LR. Pain behaviors observed during six common procedures: results from Thunder Project II*. Crit Care Med. 2004;32(2):421-7.

Alert AP. Assessing pain in the critically ill adult. Critical Care Nurse. 2014;34(1):81-3.

Azevedo-Santos IF, Alves IG, Badauê-Passos D, Santana-Filho VJ, DeSantana JM. Psychometric analysis of Behavioral Pain Scale Brazilian version in sedated and mechanically ventilated adult patients: a preliminary study. Pain Pract. 2016;16(4):451-8.

Gélinas C, Chanques G, Puntillo K. In pursuit of pain: recent advances and future directions in pain assessment in the ICU. Intensive Care Med. 2014;40(7):1009-14.

Chen HJ, Chen YM. Pain assessment: validation of the physiologic indicators in the ventilated adult patient. Pain Manag Nurs. 2015;16(2):105-11.

Ferreira N, Miranda C, Leite A, Revés L, Serra I, Fernandes AP. Dor e analgesia em doente crítico. Rev Clin Hosp Prof Dr. Fernando Fonseca. 2014;2(2):17-20.

Herr K, Coyne PJ, McCaffery M, Manworren R, Merkel S. Pain assessment in the patient unable to self-report: position statement with clinical practice recommendations. Pain Manag Nurs. 2011;12(4):230-50.

Merskey H, Bogduk N. Paint Terms, A Current List with Definitions and Notes on Usage. Classification of Chronic Pain. 2012:209-14.

Gelinas C. Nurses' evaluations of the feasibility and the clinical utility of the critical-care pain observation tool. Pain Manag Nurs. 2010;11(2):115-25.

Payen JF, Bru O, Bosson JL, Lagrasta A, Novel E, Deschaux I. Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med. 2001;29(12):2258-63.

Morete MC, Mofatto SC, Pereira CA, Silva AP, Odierna MT. Translation and cultural adaptation of the Brazilian Portuguese version of the Behavioral Pain Scale. Rev Bras Ter Intensiva. 2014;26(4):373-8.

Sessler CN, Pedram S. Protocolized and target-based sedation and analgesia in the ICU. Crit Care Clin. 2009;25(3):489-513.

Dehghani H, Tavangar H, Ghandehari A. Validity and reliability of behavioral pain scale in patients with low level of consciousness due to head trauma hospitalized in intensive care unit. Arch Trauma Res. 2014;3(1).

Sakata RK. Analgesia and sedation in intensive care unit. Rev Bras Anestesiol. 2010;60(6):648-58.

Gélinas C. Pain assessment in the critically ill adult: recent evidence and new trends. Intensive Crit Care Nurs. 2016;34:1-11.

. .

Ahlers SJ, van der Veen AM, van Dijk M, Tibboel D, Knibbe CA. The use of the Behavioral Pain Scale to assess pain in conscious sedated patients. Anesth Analg. 2010;110(1):127-33.

Robleda G, Roche-Campo F, Membrilla-Martínez L, Fernández-Lucio A, Villamor Vázquez M, Merten A. Evaluation of pain during mobilization and endotracheal aspiration in critical patients. Med Intensiva. 2016;40(2):96-104.

Gélinas C, Arbour C, Michaud C, Vaillant F, Desjardins S. Implementation of the critical-care pain observation tool on pain assessment/management nursing practices in an intensive care unit with nonverbal critically ill adults: a before and after study Int J Nurs. Stud. 2011;48(12):1495-504.

Dale J, Bjørnsen LP. Assessment of pain in a Norwegian Emergency Department. Scand J Trauma, Resusc Emerg Med. 2015;23:86.

Ribeiro MC, Pereira CU, Sallum AM, Santos AC, Nunes MS, Alves JA. Characteristics of pain in trauma victims at an emergency service. J Nurs UFPE on line,. 2012;6(4):720-7.

Azevedo-Santos IF, Alves IG, Cerqueira Neto ML, Badauê-Passos D, Santana-Filho VJ, Santana JM. Validation of the Brazilian version of Behavioral Pain Scale in adult sedated and mechanically ventilated patients. Rev Bras Anestesiol. 2017;67(3):271-7.

Ribeiro CJ, Bezerra DS, Lima AG, Fernandes CC, Menezes MG, Ribeiro MC. Pain during tracheal aspiration in patients with traumatic brain injury undergoing mechanical ventilation. Rev Dor. 2017;18(4):332-7.

De Jong A, Molinari N, de Lattre S, Gniadek C, Carr J, Conseil M. Decreasing severe pain and serious adverse events while moving intensive care unit patients: a prospective interventional study (the NURSE-DO project). Crit Care. 2013;17(2):R74.

Chen YY, Lai YH, Shun SC, Chi NH, Tsai PS, Liao YM. The Chinese Behavior Pain Scale for critically ill patients: translation and psychometric testing. Int J Nurs Stud. 2011;48(4):438-48.

Kapoustina O, Echegaray-Benites C, Gélinas C. Fluctuations in vital signs and behavioural responses of brain surgery patients in the Intensive Care Unit: are they valid indicators of pain?. J Adv Nurs. 2014;70(11):2562-76.

Gélinas C, Johnston C. Pain assessment in the critically ill ventilated adult: validation of the critical-care pain observation tool and physiologic indicators. Clin J Pain. 2007;23(6):497-505.

Gélinas C, Arbour C. Behavioral and physiologic indicators during a nociceptive procedure in conscious and unconscious mechanically ventilated adults: similar or different?. J Crit Care. 2009;24(4):628.e7-17.

Arbour C, Gélinas C. Behavioral and physiologic indicators of pain in nonverbal patients with a traumatic brain injury: an integrative review. Pain Manag Nurs. 2014;15(5):506-18.

Barr J, Fraser GL, Puntillo KA, Ely EW, Gélinas C, Dasta JF. Clinical practice guidelines for the management of pain, agitation, and delirium in adult ICU patients. Crit Care Med. 2013;41(1):263-306.

Gélinas C, Tousignant-Laflamme Y, Tanguay A, Bourgault P. Exploring the validity of the bispectral index, the critical-care pain observation tool and vital signs for the detection of pain in sedated and mechanically ventilated critically ill adults: a pilot study. Intensive Crit Care Nurs. 2011;27(1):46-52.

Submitted date:
05/10/2018

Accepted date:
02/19/2019

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