Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20200043
Brazilian Journal of Pain
Review Article

Scales for the assessment of pain in the intensive care unit. Systematic review

Escalas para a avaliação da dor na unidade de terapia intensiva. Revisão sistemática

Tássia Catiuscia Nascimento Silva da Hora; Iura Gonzalez Nogueira Alves

http://dx.doi.org/10.5935/2595-0118.20200043 BrJP, vol.3, n3, p.263-274, 2020
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Abstract

BACKGROUND AND OBJECTIVES: Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Thus, pain is difficult to evaluate, especially in patients undergoing mechanical ventilation in an intensive care unit. However, there are several instruments to assess these patients’ pain. Thus, the aims of the present study were described and characterize the psychometric characteristics of the intensive care unit pain assessment scales.

CONTENTS: A systematic review in the electronic databases of Pubmed, LILACS, Cochrane Library and Scielo was performed, without time restrictions. The focus of this evidence synthesis is to examine the validity, reproducibility, and responsiveness of intensive care unit pain scales. 58 studies were included. Cronbach alpha ranged from 0.31 to 0.96 and the intraclass correlation coefficient from 0.25 to 1.00. A cross-cultural adaptation was performed in 28 studies for use in language Portuguese (Brazil), Chinese, Italian, Swedish, Portuguese (Portugal), English, Dutch, Turkish, Persian, Danish, Polish, Spanish and Greek.

CONCLUSION: Among the available scales to measure pain in non-responsive patients, the data is not enough to indicate the superiority between them. In Brazil, most studies demonstrated that the pain scales had satisfactory validity, reliability, and reproducibility rates. Thus, when deciding which scale to use, the convenience of application and familiarity of the team should be considered.

Keywords

Critical care, Intensive care units, Pain measurement, Reproducibility of results

Resumo

JUSTIFICATIVA E OBJETIVOS: A dor é considerada como uma experiência sensorial e emocional desagradável, associada a uma lesão efetiva ou potencial dos tecidos. Avaliar a dor é muito complexo, principalmente quando se trata de pacientes ventilados mecanicamente na unidade de terapia intensiva. No entanto, existem diversas escalas para avaliam a dor desses pacientes. Dessa forma, este estudo teve como objetivo sumarizar dados acerca das características psicométricas das escalas de avaliação de dor na unidade de terapia intensiva.

CONTEÚDO: Foi realizada uma revisão sistemática através da pesquisa nas bases de dados Pubmed, LILACS, Cochrane Library e SciELO, foram incluídos os estudos que verificaram a confiabilidade, a validade, reprodutibilidade e a capacidade de resposta das escalas de avaliação de dor na unidade de terapia intensiva. Dos 58 estudos incluídos, o alfa de Cronbach variou de 0,31 a 0,96 e o coeficiente de correlação intraclasse variou de 0,25 a 1,00. Houve adaptação transcultural de 28 estudos nas versões brasileira, chinesa, italiana, sueca, portuguesa, inglesa, holandesa, turca, persa, dinamarquesa, polonesa, espanhola e grega.

CONCLUSÃO: Os estudos publicados até o momento demonstraram uma lacuna para indicar a superioridade entre as escalas que avaliam dor em pacientes em ventilação mecânica. No Brasil, a maior parte dos estudos ressaltou que as escalas de avaliação da dor apresentam índices de validade, confiabilidade e reprodutibilidade satisfatórios. Assim, a decisão entre a escala a ser utilizada deve considerar facilidade de aplicação e a familiaridade da equipe.

Palavras-chave

Cuidados críticos, Medição da dor, Reprodutibilidade dos testes, Unidade de terapia intensiva

References

Merskey H, Bogduk N. Part III: pain terms, a current list with definitions and notes on usage. Pain. 1994;2(3):209-14.

Skrobik Y, Ahern S, Leblanc M, Marquis F, Awissi DK, Kavanagh BP. Protocolized intensive care unit management of analgesia, sedation, and delirium improves analgesia and subsyndromal delirium rates. Anesth Analg. 2010;111(2):451-63.

Vervest AC, Schimmel GH. Taxonomy of pain of the IASP. Pain. 1988;34(3):318-21.

Bastos D, Silva G, Bastos I, Teixeira L. Dor. Rev Soc Bras Psicol Hosp. 2007;10(1):86-96.

Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP. Executive summary: clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):1532-48.

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. 2015;16(4):451-8.

Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):e825-73.

Wøien H. Movements and trends in intensive care pain treatment and sedation: what matters to the patient?. J Clin Nurs. 2020;29(7-8):1129-40.

Durán-Crane A, Laserna A, López-Olivo MA, Cuenca JA, Díaz DP, Cardenas YR. Clinical practice guidelines and consensus statements about pain management in critically ill end-of-life patients: a systematic review. Crit Care Med. 2019;47(11):1619-26.

Stephenson M, Riitano D, Wilson S, Leonardi-Bee J, Mabire C, Cooper K. Systematic reviews of measurement properties. Joanna Briggs Institute Reviewer's Manual. The Joanna Briggs Institute. 2017.

Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak. 2007;7:16.

Fineout-Overholt E, Johnston L. Teaching EBP: asking searchable, answerable clinical questions. Worldviews Evid Based Nurs. 2005;2(3):157-60.

Mokkink L, Terwee C, Patrick D, Alonso J, Stratford P, Knol D. COSMIN checklist manual. EMGO Institute for Health and Care Research. 2010.

Sulla F, La Chimia M, Barbieri L, Gigantiello A, Iraci C, Virgili G. A first contribution to the validation of the Italian version of the Behavioral Pain Scale in sedated, intubated, and mechanically ventilated paediatric patients. Acta Biomed. 2018;89(7-S):19-24.

Hylén M, Akerman E, Alm-Roijer C, Idvall E. Behavioral Pain Scale - translation, reliability, and validity in a Swedish context. Acta Anaesthesiol Scand. 2016;60(6):821-8.

O'Sullivan AT, Rowley S, Ellis S, Faasse K, Petrie KJ. The validity and clinical utility of the COVERS Scale and Pain Assessment Tool for Assessing Pain in Neonates Admitted to an Intensive Care Unit. Clin J Pain. 2016;32(1):51-7.

Boitor M, Fiola JL, Gélinas C. Validation of the critical-care pain observation tool and vital signs in relation to the sensory and affective components of pain during mediastinal tube removal in postoperative cardiac surgery intensive care unit adults. J Cardiovasc Nurs. 2016;31(5):425-32.

Chookalayia H, Heidarzadeh M, Hassanpour-Darghah M, Aghamohammadi-Kalkhoranb M, Karimollahi M. The critical care pain observation tool is reliable in non-agitated but not in agitated intubated patients. Intensive Crit Care Nurs. 2017;44:123-8.

Joffe AM, McNulty B, Boitor M, Marsh R, Gélinas C. Validation of the Critical-Care Pain Observation Tool in the brain-injured critically ill adults. J Crit Care. 2016;36:76-80.

Sulla F, de Souza Ramos N, Terzi N, Trenta T, Uneddu M, Zaldivar Cruces MA. Validation of the Italian version of the Critical Pain Observation Tool in brain-injured critically ill adults. Acta Biomed. 2017;88(5S):48-54.

Marmo L, Fowler S. Pain assessment tool in the critically ill post-open heart surgery patient population. Pain Manag Nurs. 2010;11(3):134-40.

Latorre-Marco I, Solís-Muñoz M, Acevedo-Nuevo M, Hernández-Sánchez ML, López-López C, Sánchez-Sánchez Mdel M. Validation of the Behavioural Indicators of Pain Scale ESCID for pain assessment in non-communicative and mechanically ventilated critically ill patients: a research protocol. J Adv Nurs. 2016;72(1):205-16.

Latorre-Marco I, Acevedo-Nuevo M, Solís-Muñoz M, Hernández-Sánchez M, López-López C, Sánchez-Sánchez MM. Psychometric validation of the behavioral indicators of pain scale for the assessment of pain in mechanically ventilated and unable to self-report critical care patients. Med Intensiva. 2016;40(8):463-73.

Klein DG, Dumpe M, Katz E, Bena J. Pain assessment in the intensive care unit: Development and psychometric testing of the nonverbal pain assessment tool. Heart Lung. 2010;39(6):521-8.

Kabes AM, Graves JK, Norris J. Further validation of the nonverbal pain scale in intensive care patients. Crit Care Nurse. 2009;29(1):59-66.

Kaya P, Erden S. Cross-cultural adaptation, validity and reliability of the Turkish version of revised nonverbal pain scale. Agri. 2019;31(1):15-22.

Spence K, Gillies D, Harrison D, Johnston L, Nagy S. A reliable pain assessment tool for clinical assessment in the neonatal intensive care unit. J Obstet Gynecol Neonatal Nurs. 2005;34(1):80-6.

McNair C, Ballantyne M, Dionne K, Stephens D, Stevens B. Postoperative pain assessment in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed. 2004;89(6):F537-41.

Nurnberg Damstrom D, Saboonchi F, Sackey PV, Bjorling G. A preliminary validation of the Swedish version of the critical-care pain observation tool in adults. Acta Anaesthesiol Scand. 2011;55(4):379-86.

Pudas-Tahka S, Salantera S. Reliability of three linguistically and culturally validated pain assessment tools for sedated ICU patients by ICU nurses in Finland. Scand J Pain. 2018;18(2):165-73.

Dionysakopoulou C, Giannakopoulou M, Lianou L, Bozas E, Zannikos K, Matziou V. Validation of Greek Versions of the Neonatal Infant Pain Scale and Premature Infant Pain Profile in Neonatal Intensive Care Unit. Pain Manag Nurs. 2018;19(3):313-9.

Cheng LH, Tsaib YF, Wang CH, Tsay PK. Validation of two Chinese-version pain observation tools in conscious and unconscious critically ill patients. Intensive Crit Care Nurs. 2018;44:115-22.

Hylén M, Alm-Roijer C, Idvall E, Akerman E. To assess patients pain in intensive care: developing and testing the Swedish version of the Behavioural Pain Scale. Intensive Crit Care Nurs. 2019;52:28-34.

Klein C, Caumo W, Gélinas C, Patines V, Pilger T, Lopes A. Validation of two pain assessment tools using a standardized nociceptive stimulation in critically ill adults. J Pain Symptom Manage. 2018;56(4):594-601.

Fagioli D, Evangelista C, Gawronski O, Tiozzo E, Broccati F, Ràva L. Pain assessment in pediatric intensive care: the Italian COMFORT behaviour scale. Nurs Child Young People. 2018;30(5):27-33.

Shan K, Cao W, Yuan Y, Hao JJ, Sun XM, He X. Use of the critical-care pain observation tool and the bispectral index for the detection of pain in brain-injured patients undergoing mechanical ventilation: A STROBE-compliant observational study. Medicine. 2018;97(22).

Ribeiro CJN, Araújo ACS, Brito SB, Dantas DV, Nunes MDS, Alves JAB. Avaliação da dor de vítimas de traumatismo crânio encefálico pela versão brasileira da Behavioral Pain Scale. Rev Bras Ter Intensiva. 2018;30(1):42-9.

Wiegand DL, Wilson T, Pannullo D, Russo MM, Kaiser KS, Soeken K. Measuring acute pain over time in the critically ill using the Multidimensional Objective Pain Assessment Tool (MOPAT). Pain Manag Nurs. 2018;19(3):277-87.

Kotfis K, Zegan-Baranska M, Strzelbicka M, Safranow K, Zukowski M, Ely EW. Validation of the Polish version of the Critical Care Pain Observation Tool (CPOT) to assess pain intensity in adult, intubated intensive care unit patients: the POL-CPOT study. Arch Med Sci. 2018;14(4):880-9.

Rijkenberg S, Stilma W, Bosman RJ, van der Meer NJ, van der Voort PHJ. Pain measurement in mechanically ventilated patients after cardiac surgery: comparison of the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT). J Cardiothorac Vasc Anesth. 2017;31(4):1227-34.

Gélinas C, Puntillo KA, Levin P, Azoulay E. The Behavior Pain Assessment Tool for critically ill adults: a validation study in 28 countries. Pain. 2017;158(5):811-21.

Azevedo-Santos IF, Alves IGN, Cerqueira Neto ML, Badauê-Passos D, Santana Filho VJ, Santana JM. Validação da versão Brasileira da Escala Comportamental de Dor (Behavioral Pain Scale) em adultos sedados e sob ventilação mecânica. Rev Bras Anestesiol. 2017;67(3):271-7.

Severgnini P, Pelosi P, Contino E, Serafinelli E, Novario R, Chiaranda M. Accuracy of Critical Care Pain Observation Tool and Behavioral Pain Scale to assess pain in critically ill conscious and unconscious patients: prospective, observational study. J Intensive Care. 2016;7(4):68.

Al Darwish ZQ, Hamdi R, Fallatah S. Evaluation of pain assessment tools in patients receiving mechanical ventilation. AACN Adv Crit Care. 2016;27(2):162-72.

Aktas YY, Karabulut N. A Turkish version of the Critical-Care Pain Observation Tool: reliability and validity assessment. J Perianesth Nurs. 2017;32(4):341-51.

Frandsen JB, O'Reilly Poulsen KS, Laerkner E, Stroem T. Validation of the Danish version of the Critical Care Pain Observation Tool. Acta Anaesthesiol Scand. 2016;60(9):1314-22.

Chen J, Lu Q, Wu XY, An YZ, Zhan YC, Zhang HY. Reliability and validity of the Chinese version of the behavioral pain scale in intubated and non-intubated critically ill patients: two cross-sectional studies. Int J Nurs Stud. 2016;61:63-71.

Rahu MA, Grap MJ, Ferguson P, Joseph P, Sherman S, Elswick Jr RK. Validity and sensitivity of 6 pain scales in critically ill, intubated adults. Am J Crit Care. 2015;24(6):514-23.

Liu Y, Li L, Herr K. Evaluation of two observational pain assessment tools in Chinese critically ill patients. Pain Med. 2015;16(8):1622-8.

Navarro-Colom M, Sendra-Lluis MA, Castillo-Masa AM, Robleda G. Fiabilidad interobservador y consistencia interna de la Behavioral Pain Scale en pacientes con ventilación mecânica. Enferm Intensiva. 2015;26(1):24-31.

Li Q, Wan X, Gu C, Yu Y, Huang W, Li S, Zhang Y. Pain assessment using the critical-care pain observation tool in Chinese critically ill ventilated adults. J Pain Symptom Manage. 2014;48(5):975-82.

Echegaray-Benites C, Kapoustina O, Gélinas C. Validation of the use of the Critical-Care Pain Observation Tool (CPOT) with brain surgery patients in the neurosurgical intensive care unit. Intensive Crit Care Nurs. 2014;30(5):257-65.

Chanques G, Pohlman A, Kress JP, Molinari N, de Jong A, Jaber S. Psychometric comparison of three behavioural scales for the assessment of pain in critically ill patients unable to self-report. Crit Care. 2014;18(5):R160.

Morete MC, Mofatto SC, Pereira CA, Silva AP, Odierna MT. Tradução e adaptação cultural da versão portuguesa (Brasil) da escala de dor Behavioural Pain Scale. Rev Bras Ter Intensiva. 2014;26(4):373-8.

Rijkenberg S, Stilma W, Endeman H, Bosman RJ, Oudemans-van Straaten HM. Pain measurement in mechanically ventilated critically ill patients: Behavioral Pain Scale versus Critical-Care Pain Observation Tool. J Crit Care. 2015;30(1):167-72.

Topolovec-Vranic J, Gélinas C, Li Y, Pollmann-Mudryj MA, Innis J, McFarlan A. Validation and evaluation of two observational pain assessment tools in a trauma and neurosurgical intensive care unit. Pain Res Manag. 2013;18(6):e107-14.

Linde SM, Badger JM, Machan JT, Beaudry J, Brucker A, Martin K. Reevaluation of the critical-care pain observation tool in intubated adults after cardiac surgery. Am J Crit Care. 2013;22(6):491-7.

Batalha LMC, Figueiredo AM, Marques M, Bizarro V. Adaptação cultural e propriedades psicométricas da versão Portuguesa da escala Behavioral Pain Scale - Intubated Patient (BPS-IP/PT). Revista de Enfermagem Referência. 2013;9:7-16.

Rivas A, Rivas E, Bustos L. Validation of a scale of assessment of pain in infants in neonatal unit. Cien Enferm. 2012;18(2):93-9.

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.

Chanques G, Viel E, Constantin JM, Jung B, de Lattre S, Carr J. The measurement of pain in intensive care unit: comparison of 5 self-report intensity scales. Pain. 2010;151(3):711-21.

Voepel-Lewis T, Zanotti J, Dammeyer JA, Merkel S. Reliability and validity of the face, legs, activity, cry, consolability, behavioral tool in assessing acute pain in critically ill patients. Am J Crit Care. 2010;19(1):55-62.

Chanques G, Payen JF, Mercier G, de Lattre S, Viel E, Jung B. Assessing pain in non-intubated critically ill patients unable to self report: an adaptation of the Behavioral Pain Scale. Intensive Care Med. 2009;35(12):2060-7.

Johansson M, Kokinsky E. The COMFORT behavioural scale and the modified FLACC scale in pediatric intensive care. Nurs Crit Care. 2009;14(3):122-30.

Holsti L, Grunau RE, Oberlander TF, Osiovich H. Is it painful or not? Discriminant validity of the Behavioral Indicators of Infant Pain (BIIP) scale. Clin J Pain. 2008;24(1):83-8.

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, Fillion L, Puntillo KA, Viens C, Fortier M. Validation of the critical-care pain observation tool in adult patients. Am J Crit Care. 2006;15(4):420-7.

Young J, Siffleet J, Nikoletti S, Shaw T. Use of a Behavioural Pain Scale to assess pain in ventilated, unconscious and/or sedated patients. Intensive Crit Care Nurs. 2006;22(1):32-9.

Marceau J. Pilot study of a pain assessment tool in the Neonatal Intensive Care Unit. J Paediatr Child Health. 2003;39(8):598-601.

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.

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

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

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.

Hamill-Ruth RJ, Marohn ML. Evaluation of pain in the critically ill patient. Crit Care Clin. 1999;15(1):35-54.

Azevedo-Santos IF, DeSantana JM. Pain measurement techniques: spotlight on mechanically ventilated patients. J Pain Res. 2018;11:2969-80.

Coleman RM, Tousignant-Laflamme Y, Ouellet P, Parenteau-Goudreault E, Cogan J, Bourgault P. The use of the bispectral index in the detection of pain in mechanically ventilated adults in the intensive care unit: a review of the literature. Pain Res Manag. 2015;20(1):e33-7.

Brocas E, Dupont H, Paugam-Burtz C, Servin F, Mantz J, Desmonts J. Bispectral index variations during tracheal suction in mechanically ventilated critically ill patients: effect of an alfentanil bolus. Intensive Care Med. 2002;28(2):211-3.

Li D, Miaskowski C, Burkhardt D, Puntillo K. Evaluations of physiologic reactivity and reflexive behaviors during noxious procedures in sedated critically ill patients. J Crit Care. 2009;24(3):472.

Submitted date:
04/03/2020

Accepted date:
05/24/2020

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