BEHAVIOURAL PAIN SCALE TO ASSESS PAIN IN SEDATED AND CONSCIOUS PATIENTS

Abstract

INTRODUCTION: Pain prevalence estimates vary by population and setting, it is about 46-80% of individuals with chronic or terminal illnesses in hospital. This pain is significant to cause both physical and psychological distress, interferes with activities of daily living, predisposes to development of adverse sequelae, impairs quality of life, and ultimately delays healing and recovery. There are various barriers for effective verbal communication in these patients such as sedation, decreased level of consciousness, endotracheal intubation, and mechanical ventilation, which are limiting factors for patients self-report of pain. To report this pain, some behavioural and physical responses can be used to assess and diagnose the pain. BPS can be used to assess pain before and after the two common procedures in unconscious ICU-admitted patients and it was reported to be a valid and reliable tool in evaluation of the pain of unconscious patients. 

MATERIAL AND METHODS: patients admitted to the ICU were evaluated for inclusion in the study once a day. Patients who were above 18 years, sedated, and ventilated for at least 8 h before assessment were included in the study. Measurement of pain by BPS scale was done by 2 observers and was recorded. Written informed consent from the patient’s relatives was obtained. Pain ranking is from 3 to 12, and the patient's status considered based on this scale is painless as 3, mild from 4–6, moderate from 7–9, or severe if ranged between10–12 pain. The scores of 6 and higher indicate moderate-to-severe pain.

RESULTS: In present study 100 patients were included.  71% patients were sedated state on all days while 18% cases were in consciously sedated state on all days and 11% patients were either in sedated or conscious sedated state on different days. 59.1% cases were male among those who were in sedated state on all days, where as 66.7% and 63.6% were males among those who were in conscious sedated state on all days and in either state on different days respectively. The amount of protocol administered was 128.9 ± 55.3 mg/hr for conscious sedated patients whereas it was 172.3 ± 72.6 mg/hr for sedated patients (P < 0.05). The difference was observed to be statistically significant. The amount of midazolam given to conscious sedated patients and sedated patients was 2.9 ± 1.8 vs 3.8 ± 2.3 mg/hr (P = 0.12). Total BPS in conscious sedated patients during rest was 3.7 ± 0.5 and during painful procedure was 5.2±1.1 this was highly significant. BPS facial expression during painful procedures Facial expression BPS was 2.4±0.9 and during rest it was 1.0±0.2. It was highly significant. CONCLUSION: For conscious sedated patients the BPS system can be validly and reliably used during painful procedures. BPS is a sensitive scale for capturing changes in pain response and discriminates between painful and nonpainful procedures.