Rahu Mamoona Arif, Grap Mary Jo, Ferguson Pam, Joseph Patty, Sherman Sarah, Elswick R K
Mamoona Arif Rahu is a clinical nurse specialist in the surgical trauma intensive care unit, Virginia Commonwealth University Medical Center, Richmond, Virginia. Mary Jo Grap is a nursing alumni endowed professor in the Adult Health and Nursing Systems, School of Nursing, Virginia Commonwealth University, Richmond, Virginia. Pam Ferguson is a clinical nurse II, Patty Joseph is a clinical nurse III and care coordinator, and Sarah Sherman is a nurse practitioner in the medical respiratory intensive care unit at Virginia Commonwealth University Medical Center. R. K. Elswick, Jr, is a professor and director of the Data Services and Analysis Core in the Department of Family and Community Health Nursing, School of Nursing; Department of Biostatistics, School of Medicine, Virginia Commonwealth University.
Am J Crit Care. 2015 Nov;24(6):514-23. doi: 10.4037/ajcc2015832.
Self-report is the best indicator of pain; however, pain is more difficult to assess in noncommunicative patients who may be receiving mechanical ventilation or sedated and unable to report pain.
To evaluate the validity and sensitivity of 6 pain scales (Adult Nonverbal Pain Scale; Behavior Pain Scale [BPS]; Comfort Scale; FACES; Face, Legs, Activity, Cry, and Consolability scale; Pain Assessment Behavioral Scale with Numeric Rating Scale [NRP]) to identify the best measure of pain in noncommunicative patients.
Fifty communicative and 100 noncommunicative patients receiving mechanical ventilation were observed before and during routine physical examination and endotracheal tube suctioning.
All pain scales had moderate to high correlations with the patient's self-report during suctioning. The FACES score reported by the patient had the highest correlation with the patient's NRP score (r = 0.76, P < .001) during suctioning; associations between the BPS and NRP scores during physical examination were the weakest (r = 0.21, P = .20). All scales were sensitive in capturing the patient's pain response in all phases (P < .001); sensitivity was higher during suctioning (P < .001). Both participants and investigators rated pain higher on the FACES scale.
These pain scales commonly used in noncommunicative critically ill adult patients are valid and sensitive for capturing changes in pain response during suctioning in both communicative and noncommunicative patients. However, caution must be used when using the FACES scale because subjectivity may lead to overtreatment or undertreatment of pain.
自我报告是疼痛的最佳指标；然而，对于可能正在接受机械通气或处于镇静状态且无法报告疼痛的无交流能力患者，疼痛评估更为困难。
评估6种疼痛量表（成人非语言疼痛量表；行为疼痛量表[BPS]；舒适度量表；面部表情量表；面部、腿部、活动、哭闹及安慰度量表；带数字评分量表的疼痛评估行为量表[NRP]）在识别无交流能力患者最佳疼痛测量方法方面的有效性和敏感性。
对50名有交流能力和100名接受机械通气的无交流能力患者在常规体格检查和气管内吸痰前及过程中进行观察。
所有疼痛量表在吸痰期间与患者的自我报告均具有中度至高相关性。在吸痰期间，患者报告的面部表情量表得分与患者的数字评分量表得分相关性最高（r = 0.76，P <.001）；体格检查期间行为疼痛量表与数字评分量表得分之间的相关性最弱（r = 0.21，P =.20）。所有量表在各个阶段捕捉患者疼痛反应方面均具有敏感性（P <.001）；在吸痰期间敏感性更高（P <.001）。参与者和研究者对面部表情量表的疼痛评分均更高。
这些常用于无交流能力成年危重症患者的疼痛量表，对于捕捉有交流能力和无交流能力患者在吸痰期间疼痛反应的变化是有效且敏感的。然而，使用面部表情量表时必须谨慎，因为主观性可能导致疼痛治疗过度或不足。
