The Use of the Behavioral Pain Scale to Assess Pain in Conscious Sedated Patients

Sabine J. G. M. Ahlers, Aletta M. van der Veen, Monique van Dijk, Dick Tibboel, Catherijne A. J. Knibbe,

Anesthesia & Analgesia Vol. 110, No. 1, 2010 

Background: pain assessment in mechanically ventilated critically ill patients is a great challenge. An adequate pain measurement tool is needed in conscious sedated patients because of their questionable communicative abilities. In this study, we evaluated the use of the Behavioral Pain Scale (BPS) in conscious sedated patients in comparison with its use in deeply sedated patients, for whom the BPS was developed. Additionally, the combination of the BPS and the patient-rated Verbal Rating Scale (VRS-4) was evaluated in conscious sedated patients.

Methods: we performed a prospective evaluation study in 80 nonparalyzed critically ill adult intensive care patients. Nurses performed 175 observation series over 2 months (126 in deeply sedated patients and 49 in conscious sedated patients). Each observation series consisted of BPS ratings (range 3–12) at 4 points: at rest, during a nonpainful procedure, at retest rest, and during a routine painful procedure. Patients in the conscious sedated state also self-reported their pain using the 4-point VRS-4.

Results: BPS scores during painful procedures were significantly higher than those at rest, both in deeply sedated patients (5.1 [4.8 –5.5] vs 3.4 [3.3–3.5], respectively) and conscious sedated patients (5.4 [4.9 –5.9] vs 3.8 [3.5– 4.1], respectively) (mean [95% confidence interval]). For both groups, scores obtained during the nonpainful procedure and at rest did not significantly differ. There was a strong correlation between nurses’ BPS ratings and conscious sedated patients’ VRS-4 ratings during the painful procedure (r_S = 0.67, P < 0.001). At rest and during nonpainful procedures, 98% of the observations were rated as acceptable pain (VRS 1 or 2) by both nurses and patients. During painful procedures, nurses rated the pain higher than patients did in 16% of the observations and lower in 12% of the observations.

Conclusion: the BPS is a valid tool for measuring pain in conscious sedated patients during painful procedures. Thus, for noncommunicative and mechanically ventilated patients, it may be regarded as a bridge between the observational scale used by nurses and the VRS-4 used by patients who are able to self-report pain.

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