title: Clinical tools for the assessment of pain in sedated critically ill adults.
abstract: OBJECTIVE
  This paper aims to review the evidence regarding pain assessment tools for sedated patients and to establish whether the use of a tool can be recommended in practice.
  
  
  BACKGROUND
  Pain assessment is a challenging area of critical care nursing practice, particularly among sedated patients. Tools to aid in assessing pain among this patient group have been developed and tested recently.
  
  
  METHODS
  In this systematic review five papers that tested pain assessment tools for sedated patients are discussed. These papers were identified via the CINAHL and MEDLINE databases using the search terms: 'pain assessment' and 'sedated' or 'unconscious' or 'critically ill' or 'critical illness' or 'critical care'.
  
  
  CONCLUSIONS
  The Behavioural Pain Scale (BPS) has been tested among the broadest range of patients and was found to be a reliable and valid tool in three studies. Research is needed to further demonstrate the reliability and validity of the Critical-Care Pain Observation Tool (CPOT), as the paper of Gelinas et al. did not test its internal consistency and domain structure. The CPOT also needs testing among different critical care populations. The design of Odhner et al. study did not allow adequate testing of the Non-verbal Pain Scale (NVPS).
  
  
  CONCLUSIONS
  The implementation of the BPS can be recommended in intensive care units and may improve the management of pain among sedated patients by providing a systematic and consistent approach to pain assessment to guide interventions. The CPOT may also prove useful in assessing pain among sedated patients, but first requires further validation. Also, further research is needed into the effects of pain assessment tools on pain management practices and patient outcomes.
authors.affiliation: Critical Care Unit, Colchester Hospital University NHS Foundation Trust, Colchester, Essex, UK. clare_cade@hotmail.com
authors.forename: Clare H
authors.initials: CH
authors.lastname: Cade
mesh_terms: D000328:Adult; D003144:Communication Barriers; D016292:Procedural Sedation / Q000009:adverse effects / Q000451:nursing*; D003422:Critical Care / Q000379:methods* / Q000592:standards; D016638:Critical Illness / Q000451:nursing*; D003625:Data Collection; D003627:Data Interpretation, Statistical; D055318:Evidence-Based Nursing; D006801:Humans; D009633:Nonverbal Communication; D009730:Nursing Assessment / Q000379:methods* / Q000592:standards; D015403:Nursing Evaluation Research / Q000458:organization & administration; D015588:Observer Variation; D010146:Pain / Q000175:diagnosis* / Q000209:etiology / Q000451:nursing; D010147:Pain Measurement / Q000379:methods* / Q000451:nursing / Q000592:standards; D015203:Reproducibility of Results; D012107:Research Design; D012720:Severity of Illness Index; D014474:Unconsciousness / Q000150:complications / Q000451:nursing