The Critical-Care Pain Observation Tool: A useful tool for pain assessment in intensive care units

Document Type: Review Article

Authors

1 Pulmonologist, Lung Disease Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Resident of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Pulmonologist, Lung Diseases Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Resident of Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Pain is a major concern in all intensive care units (ICUs). The proper assessment and management of pain is one of the main goals of patient care in ICUs. Improper evaluation of pain and its over or under treatment can cause significant problems in the process of patient management in ICU. Since most ICU patients are unable to communicate correctly with the ICU team and explain their level of pain, pain assessment can be challenging. Thus, several assessment tools for the evaluation of pain were developed, few of which were validated. Critical Care Pain Observation Tool is a valid and reliable instrument for pain assessment in different ICUs.

Keywords


1.Stanik-Hutt JA, Soeken KL, Belcher AE, Fontaine DK, Gift AG. Pain experiences of traumatically injured patients in a critical care setting. Am J Crit Care. 2001;10(4):252–9.

2. Payen JF, Bosson JL, Chanques G, Mantz J, Labarere J. Pain assessment is associated with decreased duration of mechanical ventilation in the intensive care unit: A post hoc analysis of the DOLOREA study. Anesthesiology. 2009;111:1308–16.

3. Topolovec-Vranic J, Gelinas C, Li Y, Pollmann-Mudryj MA, Innis J, McFarlan A,  Canzian S. Validation and evaluation of two observational pain assessment tools in a trauma and neurosurgical intensive care unit. Pain Res Manag. 2013 ;18(6):e107-14.

4. Malchow RJ, Black IH. The evolution of pain management in the critically ill trauma patient: Emerging concepts from the global war on terrorism. Crit Care Med. 2008;36:S346–S357. 

5. van GL, Ahlers SJ, Brkic Z, et al. Improved analgesia after the realisation of a pain management programme in ICU patients after cardiac surgery. Eur J Anaesthesiol. 2010;27:900–

6. Rijkenberg S, van der Voort PH. Can the critical-care pain observation tool (CPOT) be used to assess pain in delirious ICU patients? J Thorac Dis. 2016;8(5):E285-7.

7. Ahlers SJ, van Gulik L, van der Veen AM, van Dongen HP, Bruins P, Belitser SV, de Boer A, Tibboel D, Knibbe CA. Comparison of different pain scoring systems in  critically ill patients in a general ICU. Crit Care. 2008;12(1):R15.

8.Gélinas C, Fillion L, Puntillo KA, Viens C, Fortier M. Validation of the critical-care pain observation tool in adult patients. Am J Crit Care. 2006 ;15(4):420-7.

9. Kollef MH, Levy NT, Ahrens TS, Schaiff R, Prentice D, Sherman G: The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation. Chest 1998, 114: 541-548. 

10. Kress JP, Pohlman AS, O'Connor MF, Hall JB: Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000, 342: 1471-1477. 

11. Hajiesmaeili MR, Safari S. Pain Management in the Intensive Care Unit: Do We Need Special Protocols? Anesthesiology and Pain Medicine. 2012;1(4):237-238. 

12. Juarez P, Bach A, Baker M, et al. Comparison of two pain scales for the assessment of pain in the ventilated adult patient. Dimens Crit Care Nurs. 2010;29:307–15.

13. Herr K, Coyne PJ, McCaffery M, Manworren R, Merkel S. Pain assessment in the patient unable to self-report: Position statement with clinical practice recommendations. Pain Manag Nurs. 2011;12:230–50. 

14.. Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41:263–306. 

15. Odhner M, Wegman D, Freeland N, Steinmetz A, Ingersoll GL. Assessing pain control in nonverbal critically ill adults. DCCN – Dimensions of Critical Care Nursing. 2003;22:260–7.

16. Ribeiro CJN, de Araújo ACS, Brito SB, et al. Pain assessment of traumatic brain injury victims using the Brazilian version of the Behavioral Pain Scale. Revista Brasileira de Terapia Intensiva. 2018;30(1):42-49.

17. Gélinas C, Johnston C. Pain assessment in the critically ill ventilated adult: Validation of the Critical-Care Pain Observation Tool and physiologic indicators. Clin J Pain. 2007;23:497–505. 

18. Gélinas C, Fillion L, Puntillo KA. Item selection and content validity of the Critical-Care Pain Observation Tool for non-verbal adults. J Adv Nurs. 2009;65:203–16. 

19. Gélinas C, Tousignant-Laflamme Y, Tanguay A, Bourgault P. Exploring the validity of the bispectral index, the Critical-Care Pain Observation Tool and vital signs for the detection of pain in sedated and mechanically ventilated critically ill adults: A pilot study. Intensive Crit Care Nurs. 2011;27:46–52. 

20. Assessing pain in the critically ill adult. Crit Care Nurse. 2014;34(1):81-3.