Assessing pain in critically ill adults unable to self-report: BPS vs. CPOT

Abstract

OVERVIEW OF THE TOPIC: Pain assessment in the ICU is challenging to attain as certain health conditions may diminish or alter the patients' communicative abilities. According to the Hierarchy of Pain Assessment Techniques (Herr et al., 2011) the suggested approach in cases where patients are unable to self-report, is observation of the patients' behaviours. Standardized behavioural tools have been established to aid in pain assessment. THE RESEARCH QUESTION and PICO ELEMENTS: How do the psychometric properties of the Behavioural Pain Scale (BPS) (I) compare to those of the Critical-Care Pain Observation Tool (CPOT) (C) to enhance pain assessment (O) in the ICU for adult patients unable to self-report (P)? The INCLUSION criteria for the selected studies were limited to: papers written in the English language, published between 2003 and 2013; non-interactive patients 18 years and over and studies which addressed the BPS and/or CPOT. Studies taking place outside the ICU and addressing infants, children, cognitively impaired patients and brain associated problems were EXCLUDED. SEARCH OUTCOME: 8 studies were retrieved; 2 pre-experimental studies, 4 systematic reviews, 1 cohort study and 1 descriptive qualitative study. METHODS OF APPRAISAL: The CASP and TREND tools were used to critically appraise the selected studies. RESULTS: The included studies show the sufficient validity and reliability of the BPS, and to a higher extent, the CPOT. The CPOT also rendered positive feasibility results. CONCLUSION: The CPOT seems to be superior in quality and is evidently proven to enhance pain assessment. However, this needs further testing to be established as the 'gold standard'. RECOMMENDATIONS/IMPLICATIONS: Further CPOT testing is recommended amongst general ICU patients. Further psychometric evaluation is also suggested, to facilitate the comparison between the two pain behavioural instruments. Locally, educational sessions are needed to enhance the knowledge base on pain assessment practices together with further research to aid in the implementation of a behavioural assessment tool in the ICU/ITU.