Assessing pain in non-intubated critically ill patients unable to self report

An adaptation of the Behavioral Pain Scale

Gérald Chanques, Jean François Payen, Grégoire Mercier, Sylvie De Lattre, Eric Viel, Boris Jung, Moussa Cissé, Jean Yves Lefrant, Samir Jaber

Research output: Contribution to journalArticle

Abstract

Purpose: To validate an adaptation of the Behavioral Pain Scale (BPS) for its use in non-intubated intensive care unit (ICU) patients unable to self-report their pain because of the occurrence of delirium. The "vocalization" domain was inserted to construct the BPS-non intubated (BPS-NI) scale, ranging from 3 (no pain) to 12 (most pain). Design: Prospective psychometric study in a medical-surgical ICU. Methods: The same physician and one bedside nurse rated pain in non-intubated patients unable to self-report their pain during four conditions: before and after a catheter dressing change (non-nociceptive procedure) and before and after turning the patient (nociceptive procedure). Delirium was assessed by the Confusion Assessment Method for the ICU (CAM-ICU). Results: A total of 120 paired evaluations were performed in 30 consecutive adult patients, 84% with delirium (CAM-ICU positive). BPS-NI scores were higher during painful procedures than at rest [6.0 (5.0-8.0) vs. 3.0 (3.0-3.8); P <0.001], while no changes in BPS-NI scores were found during non-nociceptive procedures (discriminative validity). The BPS-NI had good internal consistency (standardized Cronbach α = 0.79), and each domain reflected the pain expression factor in a balanced way (coefficients between 0.57 and 0.59). The BPS-NI had a good inter-rater reliability (weighted kappa coefficient = 0.89 for the four conditions and 0.82 during nociceptive procedures) and a good responsiveness, with an effect size ranging from 1.5 to 3.6. Conclusions: Pain during procedures is perceived even in non-intubated ICU patients with delirium. In those patients, pain level can be assessed with the BPS-NI scale since this instrument exhibited good psychometric properties.

Original languageEnglish (US)
Pages (from-to)2060-2067
Number of pages8
JournalIntensive Care Medicine
Volume35
Issue number12
DOIs
StatePublished - Dec 2009
Externally publishedYes

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Critical Illness
Self Report
Pain
Delirium
Intensive Care Units
Confusion
Psychometrics
Critical Care
Bandages
Catheters
Nurses

Keywords

  • Analgesia
  • Critical care
  • Delirium
  • Intensive care
  • Pain
  • Pain measurement
  • Psychomotor agitation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Assessing pain in non-intubated critically ill patients unable to self report : An adaptation of the Behavioral Pain Scale. / Chanques, Gérald; Payen, Jean François; Mercier, Grégoire; De Lattre, Sylvie; Viel, Eric; Jung, Boris; Cissé, Moussa; Lefrant, Jean Yves; Jaber, Samir.

In: Intensive Care Medicine, Vol. 35, No. 12, 12.2009, p. 2060-2067.

Research output: Contribution to journalArticle

Chanques, G, Payen, JF, Mercier, G, De Lattre, S, Viel, E, Jung, B, Cissé, M, Lefrant, JY & Jaber, S 2009, 'Assessing pain in non-intubated critically ill patients unable to self report: An adaptation of the Behavioral Pain Scale', Intensive Care Medicine, vol. 35, no. 12, pp. 2060-2067. https://doi.org/10.1007/s00134-009-1590-5
Chanques, Gérald ; Payen, Jean François ; Mercier, Grégoire ; De Lattre, Sylvie ; Viel, Eric ; Jung, Boris ; Cissé, Moussa ; Lefrant, Jean Yves ; Jaber, Samir. / Assessing pain in non-intubated critically ill patients unable to self report : An adaptation of the Behavioral Pain Scale. In: Intensive Care Medicine. 2009 ; Vol. 35, No. 12. pp. 2060-2067.
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