Measuring pain levels in critically ill patients, especially in those who cannot communicate verbally, is crucial in administering care. A study published in PAIN introduces a new behavior pain assessment tool (BPAT) capable of evaluating pain levels through nonverbal cues.

Led by Céline Gélinas, RN, PhD, of McGill University in Montreal, the study measured effectiveness of the BPAT in evaluating pain in the intensive care unit (ICU). Many patients in the ICU are unable to communicate verbally due to their clinical condition, level of awareness, ventilation interference and sedation, leaving the tool to measure pain levels through observable behaviors such as facial expressions, verbal responses and muscle responses.

"Since none of those conditions precludes the perception of pain, it is essential that clinicians have valid and reliable pain assessment methods," Gélinas and coauthors write.

The BPAT, which is available in 12 languages, was tested in more than 4,800 procedures in 3,850 patients from 192 ICUs in 28 countries. Pain was measured on the BPAT eight-point scale and was found to correlate with the pain ratings made my patients capable of verbal communication. At the point pain levels surpassed 3.5, BPAT was accurate in identifying more severe pain levels and patients in need of additional pain medications. The study showed that facial grimacing was the most common for nonverbal pain indication followed by wincing, moaning, verbal complaints and clenched fists

"The BPAT was found to be reliable and valid for use in critically ill patients unable to self-report," Gélinas and colleagues conclude. "Valid behavioral pain scales are necessary to ensure appropriate assessment of pain and to guide decisions for pain management in this vulnerable population."