Most used pain assessment scales in the unconscious critical patient: a systematic review

Abstract

Introduction: The evaluation and registry of pain intensity by health professionals should be performed in a continuous and regular manner, in the same way as in vital signs, in order to optimize therapy [1]. However, this assessment may be difficult for a critically ill patient with changes in consciousness. It is essential to use specific pain assessment scales for this clinical situation. The aim of this review is to identify the most used pain assessment scales for the critically ill unconscious adult patient to ensure the humanization of health care.

Materials and methods: The research question of this review is: Which are the most used scales for the evaluation of pain (I) in the critically ill unconscious adult patient (P), that ensure the humanization of health care (O). This systematic literature review was conducted through scientific research, in the time space of February 2012 to February 2018 in the B-On and Ebscohost databases. Inclusion criteria: unconscious critically ill patient of 18 years of age or older; studies that refer to pain assessment scales; studies whose results include pain assessment. Exclusion criteria: all the documents that not incorporate the inclusion criteria. Keywords: pain assessment; unconscious critically ill patient; pain; nursing. 264 studies were selected by exclusion and inclusion criteria, 102 studies were selected accordingly to the aim of the review and 4 articles were selected through integral text reading.

Results: In the study developed by Asadi-Noghabi, Gholizadeh, Zolfaghari, Sohrabi, & Mehran [2] the Critical-Care Pain Observation Tool (CPOT) scale is the most successfully applied, having a positive impact on pain control in patients with altered consciousness. Payen & Gélinas [3] report that the best alternative to assess pain in the non-communicating patient is the use of behavioral scales. Of the eight scales developed for adults hospitalized in Intensive Care Units, the Behavioral Pain Scale (BPS) and the CPOT are the most appropriated. Severino, Pelosi, Serafinelli, Novario, & Chiaranda [4] concluded that both scales, CPOT and BPS, when used in consonance, are valuable tools for pain management in critically ill patients admitted to the ICU. Teixeira & Durão [5] report that the results obtained indicate that the BPS and CPOT scales are the most appropriate for pain assessment in patients with altered consciousness.

Discussion and conclusions: The assessment of pain is of great importance in all patients, being even more evident in the unconscious critically ill patients for the improvement and humanization of provided care as for the adequacy of the indicated treatment. All the studies consulted are in agreement with the most successful scales for the evaluation of pain in these patients, referring to CPOT and BPS as indicated.