title: Assessing pain behaviors in healthy subjects using the Critical-Care Pain Observation Tool (CPOT): a pilot study.
abstract: The Critical-Care Pain Observation Tool (CPOT) is a behavioral scale recommended by experts for pain assessment in critically ill patients unable to verbally communicate. The main goal of this study was to determine the relationship between self-reports of pain intensity and the CPOT score, and establish the sensibility and the specificity of the CPOT to different levels of pain intensity in healthy subjects. A total of 18 healthy subjects participated in the study (mean age = 37.8 years). All subjects underwent a 2 minutes noxious cold pressor test (CPT) at 7°C. Verbal pain ratings were obtained with a visual analog scale (0-100) while pain behaviors were videotaped. Afterwards, 2 independent evaluators quantified pain behaviors using the CPOT. Interrater reliability was supported with an ICC of 0.963 (95%CI [0.904-0.986]). A moderate positive correlation between the CPOT scores and self-reports of pain intensity during the CPT was found (r = 0.52, p = 0.028). Such result indicates that subjects reporting high level of pain showed a higher number or more intense pain behaviors. A cut-off score >2.5/8 on the CPOT led to a sensibility of 64% and a specificity of 86%. Results from this pilot study support that an increase of CPOT score is correlated with moderate to high levels of pain intensity and further support the clinical use of the CPOT.
  
  
  CONCLUSIONS
  This article presents the psychometric properties of a behavioral pain scale called the CPOT which was developed to assess pain in critically ill adults unable to self-report. Our results in healthy subjects showed that the CPOT behavioral score is significantly correlated with the self-report of pain intensity and supports its clinical use.
authors.affiliation: Université de Sherbrooke, School of Rehabilitation, Faculty of Medicine and Health Sciences, Sherbrooke, Quebec, Canada. yannick.tousignant-laflamme@usherbrooke.ca
authors.forename: Yannick
authors.initials: Y
authors.lastname: Tousignant-Laflamme
authors.forename: Patricia
authors.initials: P
authors.lastname: Bourgault
authors.forename: Céline
authors.initials: C
authors.lastname: Gélinas
authors.forename: Serge
authors.initials: S
authors.lastname: Marchand
mesh_terms: D000328:Adult; D003080:Cold Temperature / Q000009:adverse effects; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D055809:Illness Behavior / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000592:standards*; D015588:Observer Variation; D010146:Pain / Q000175:diagnosis* / Q000523:psychology; D010147:Pain Measurement / Q000379:methods*; D017288:Pain Threshold / Q000502:physiology; D010865:Pilot Projects; D012016:Reference Values