Comparison of two behavioural pain scales for the assessment of procedural pain: A systematic review

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Abstract

Aim

To examine the clinical utility and measurement properties of the Critical‐Care Pain Observation Tool and the Behavioural Pain Scale when used to assess pain during procedures in the intensive care unit.

Design

A systematic review was conducted, guided by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses checklist.

Methods

A systematic search was conducted in CINAHL, MEDLINE, EMBASE and PsychINFO (01 October 2019). Study selection, data extraction and assessment of methodological quality were performed by a pair of authors working independently. Different psychometric properties were addressed: inter‐rater reliability, internal consistency, test–retest reliability, discriminant validity and criterion validity.

Results

Eleven studies were included. Both Critical‐Care Pain Observation Tool and the Behavioural Pain Scale showed good reliability and validity and were good options for assessing pain during painful procedures with intensive care unit patients unable to self‐report on pain. The Critical‐Care Pain Observation Tool is to be preferred since this tool was shown to have particularly good reliability and validity in assessing pain during procedures, but the Behavioural Pain Scale is an appropriate alternative.

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Most cited references 47

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Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

David Moher, Alessandro Liberati, Jennifer Tetzlaff … (2011)

David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses

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Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit.

Juliana Barr, Gilles L Fraser, Kathleen Puntillo … (2013)

To revise the "Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult" published in Critical Care Medicine in 2002. The American College of Critical Care Medicine assembled a 20-person, multidisciplinary, multi-institutional task force with expertise in guideline development, pain, agitation and sedation, delirium management, and associated outcomes in adult critically ill patients. The task force, divided into four subcommittees, collaborated over 6 yr in person, via teleconferences, and via electronic communication. Subcommittees were responsible for developing relevant clinical questions, using the Grading of Recommendations Assessment, Development and Evaluation method (http://www.gradeworkinggroup.org) to review, evaluate, and summarize the literature, and to develop clinical statements (descriptive) and recommendations (actionable). With the help of a professional librarian and Refworks database software, they developed a Web-based electronic database of over 19,000 references extracted from eight clinical search engines, related to pain and analgesia, agitation and sedation, delirium, and related clinical outcomes in adult ICU patients. The group also used psychometric analyses to evaluate and compare pain, agitation/sedation, and delirium assessment tools. All task force members were allowed to review the literature supporting each statement and recommendation and provided feedback to the subcommittees. Group consensus was achieved for all statements and recommendations using the nominal group technique and the modified Delphi method, with anonymous voting by all task force members using E-Survey (http://www.esurvey.com). All voting was completed in December 2010. Relevant studies published after this date and prior to publication of these guidelines were referenced in the text. The quality of evidence for each statement and recommendation was ranked as high (A), moderate (B), or low/very low (C). The strength of recommendations was ranked as strong (1) or weak (2), and either in favor of (+) or against (-) an intervention. A strong recommendation (either for or against) indicated that the intervention's desirable effects either clearly outweighed its undesirable effects (risks, burdens, and costs) or it did not. For all strong recommendations, the phrase "We recommend …" is used throughout. A weak recommendation, either for or against an intervention, indicated that the trade-off between desirable and undesirable effects was less clear. For all weak recommendations, the phrase "We suggest …" is used throughout. In the absence of sufficient evidence, or when group consensus could not be achieved, no recommendation (0) was made. Consensus based on expert opinion was not used as a substitute for a lack of evidence. A consistent method for addressing potential conflict of interest was followed if task force members were coauthors of related research. The development of this guideline was independent of any industry funding. These guidelines provide a roadmap for developing integrated, evidence-based, and patient-centered protocols for preventing and treating pain, agitation, and delirium in critically ill patients.

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Assessment of pain.

H Breivik, P C Borchgrevink, S Allen … (2008)

Valid and reliable assessment of pain is essential for both clinical trials and effective pain management. The nature of pain makes objective measurement impossible. Acute pain can be reliably assessed, both at rest (important for comfort) and during movement (important for function and risk of postoperative complications), with one-dimensional tools such as numeric rating scales or visual analogue scales. Both these are more powerful in detecting changes in pain intensity than a verbal categorical rating scale. In acute pain trials, assessment of baseline pain must ensure sufficient pain intensity for the trial to detect meaningful treatment effects. Chronic pain assessment and its impact on physical, emotional, and social functions require multidimensional qualitative tools and health-related quality of life instruments. Several disease- and patient-specific functional scales are useful, such as the Western Ontario and MacMaster Universities for osteoarthritis, and several neuropathic pain screening tools. The Initiative on Measurement, and Pain Assessment in Clinical Trials recommendations for outcome measurements of chronic pain trials are also useful for routine assessment. Cancer pain assessment is complicated by a number of other bodily and mental symptoms such as fatigue and depression, all affecting quality of life. It is noteworthy that quality of life reported by chronic pain patients can be as much affected as that of terminal cancer patients. Any assessment of pain must take into account other factors, such as cognitive impairment or dementia, and assessment tools validated in the specific patient groups being studied.

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Author and article information

Contributors

Marianne Trygg Solberg:

ORCID: https://orcid.org/0000-0002-2828-0759

marianne.trygg.solberg@ldh.no

Journal

Journal ID (nlm-ta): Nurs Open

Journal ID (iso-abbrev): Nurs Open

Journal ID (doi): 10.1002/(ISSN)2054-1058

Journal ID (publisher-id): NOP2

Title: Nursing Open

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Electronic): 2054-1058

Publication date (Electronic): 28 November 2020

Publication date Collection: September 2021

Volume: 8

Issue: 5 ( doiID: 10.1002/nop2.v8.5 )

Pages: 2050-2060

Affiliations

[ ¹ ] Department for Postgraduate Studies Lovisenberg Diaconal University College Oslo Norway

[ ² ] Diakonhjemmet Hospital Oslo Norway

Author notes

[*] [* ] Correspondence

Marianne Trygg Solberg, Lovisenberg Diakonale Høgskole, Lovisenberggt 15b, 0456 Oslo, Norway.

Email: marianne.trygg.solberg@ 123456ldh.no

Author information

Marie Hamilton Larsen https://orcid.org/0000-0001-9113-1062

Simen A. Steindal https://orcid.org/0000-0002-7676-8900

Marianne Trygg Solberg https://orcid.org/0000-0002-2828-0759

Article

Publisher ID: NOP2714

DOI: 10.1002/nop2.714

PMC ID: 8363347

PubMed ID: 34388865

SO-VID: 4899d6a7-192f-44d1-8c3a-4e607cb0921a

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

History

Date revision received : 23 September 2020

Date received : 15 June 2020

Date accepted : 05 November 2020

Page count

Figures: 1, Tables: 2, Pages: 11, Words: 7170

Custom metadata

source-schema-version-number 2.0

cover-date September 2021

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.5 mode:remove_FC converted:13.08.2021

Keywords: behavioural pain scale,critical‐care pain observation tool,intensive care,pain assessment,systematic literature review

Data availability:

Keywords: behavioural pain scale, critical‐care pain observation tool, intensive care, pain assessment, systematic literature review

Comparison of two behavioural pain scales for the assessment of procedural pain: A systematic review

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Pediatric Pulse: Advancing Neonatal and Child Health

Most cited references 47

Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit.

Assessment of pain.

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