Brazilian Journal of Pain
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

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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.


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


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.


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


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