title: Validity and sensitivity of 6 pain scales in critically ill, intubated adults.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  Fifty communicative and 100 noncommunicative patients receiving mechanical ventilation were observed before and during routine physical examination and endotracheal tube suctioning.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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. Mamoona.arif@vcuhealth.org.
authors.forename: Mamoona Arif
authors.initials: MA
authors.lastname: Rahu
authors.affiliation: 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.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Grap
authors.affiliation: 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.
authors.forename: Pam
authors.initials: P
authors.lastname: Ferguson
authors.affiliation: 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.
authors.forename: Patty
authors.initials: P
authors.lastname: Joseph
authors.affiliation: 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.
authors.forename: Sarah
authors.initials: S
authors.lastname: Sherman
authors.affiliation: 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.
authors.forename: R K
authors.initials: RK
authors.lastname: Elswick
mesh_terms: D016638:Critical Illness; D005149:Facial Expression; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009633:Nonverbal Communication; D010147:Pain Measurement / Q000379:methods* / Q000592:standards* / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D012680:Sensitivity and Specificity