Comparison of Behavioral Pain Scale and Critical Care Pain Observation Tool in Pain Score of Trauma Patients in Intensive Care Units
Abstract
Background: Pain assessment is a major clinical challenge in intensive care units. We aimed to evaluate and compare the CPOT and BPS scales for pain monitoring in ventilator-dependent trauma patients.
Methods: In this observational study, ICU trauma patients were assessed using three instruments: WBF, BPS, and CPOT. Pain scores were recorded at pre-procedure, intra-procedure, and post-procedure time points. Statistical analysis was performed using SPSS v.16.
Results: The results showed the M (SD) status of the overall score of the CPOT tool was 3.79 (2.41) in Assessment 1, 5.08 (1.76) in Assessment 2, and 3.92 (1.29) in Assessment 3. Also, the M(SD) status of the overall score of the BPS instrument was 8.55 (1.72) in Assessment 1, 9.71 (1.72) in Assessment 2, and 9.4 (1.24) in Assessment 3. Regarding the WBF tool, it was also shown that the M (SD) status of the overall score in Assessment 1 was 4.83 (1.97), in Assessment 2 it was 6.61 (2.32), and in Assessment 3 it was 5.46 (2.21). Also, the result showed there was a significant relationship between the CPOT & WBF tools in all 3 stages of pain assessment (p=0.000). While there was a significant correlation between BPS and WBF tools in the 1st and 2nd stages of pain measurement (p = 0.000), no significant relationship was observed in the third stage (p = 0.71). Also, regarding the correlation between CPOT & BPS tools, it was shown that there was a correlation in the first and second stages, but there was no correlation in the third stage of pain initiation (p=0.71).
Conclusion: Both the tools used, including CPOT and BPS, are considered effective and practical for these patients, but the CPOT tool has a better performance than the BPS tool.
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[12] Correya A, Rawson H, Ockerby C, Hutchinson AM. Nurses' perceptions of patient pain, delirium, and sedation assessments in the intensive care unit: A qualitative study. Aust Crit Care. 2025; 38(1):101076.
[13] Abrahams Simbeye J, Sharifi F, Navab E, Bahramnezhad F. Investigating Nurses’ Knowledge, Attitude, and Performance Regarding Pain Management of Non-verbal Critically-Ill Patients in Tanzania Intensive Care Units. JCCNC. 2024; 10(1):25-34.
[14] Alotni M, Guilhermino M, Duff J, Sim J. Barriers to nurse-led pain management for adult patients in intensive care units: An integrative review. Aust Crit Care. 2023; 36(5):855-862.
[15] Abdalrahim MS, Hamdan KM, Shaheen AM. Importance of preemptive analgesia and pain assessment as perceived by intensive care unit nurses. Br J Pain. 2023; 17(4):400-407.
[16] Shahiri TS, Gélinas C. The Validity of Vital Signs for Pain Assessment in Critically Ill Adults: A Narrative Review. Pain Manag Nurs. 2023; 24(3):318-328.
[17] Gomez RJ, Barrowman N, Elia S, Manias E, et al. Establishing intra- and inter-rater agreement of the Face, Legs, Activity, Cry, Consolability scale for evaluating pain in toddlers during immunization. Pain Res Manag. 2013; 18(6):e124-8.
[18] Rijkenberg S, van der Voort PH. Can the critical-care pain observation tool (CPOT) be used to assess pain in delirious ICU patients? J Thorac Dis. 2016; 8(5):E285-7.
[19] Kelly MA, Slatyer S, Tutticci N, Ramsbotham J, et al. Challenging the nuances of pain assessment with co-designed audio-visual simulations in nursing education: A descriptive study. Clin Simulation Nurs. 2024; 87:101510.
[20] Larson S, Laures E, Seo M, Cox M, et al. Evidence-Based Pain Assessment in Nonverbal Palliative Care Patients. Pain Manag Nurs. 2024; 25(2):152-159.
[21] Taghinezhad F, Raiesifar A, Taghinezhad Y, Mohammadi E. Professional Quality of Life among Iranian Clinical Nurses at the Forefront of the Fight against COVID-19: A Multicenter Cross-Sectional Study. Iran J Nurs Midwifery Res. 2024; 29(2):187-193.
[22] Taghinezhad F, Safavi M, Raiesifar A, Yahyavi SH. Antecedents of organizational citizenship behavior among Iranian nurses: a multicenter study. BMC Res Notes. 2015; 8:547.
[23] Wong DL, Baker CM. Wong-Baker faces pain rating scale. Pain Manag Nurs. 2012.
[24] Nazari R, Sharifnia H, Mousazadeh N, Hasani A. Validation of the Persian Version of Critical Care Pain Observation Tool. JCC Nursing. 2021; 14(3):51-59.
[25] Buttes P, Keal G, Cronin SN, Stocks L, et al. Validation of the critical-care pain observation tool in adult critically ill patients. Dimens Crit Care Nurs. 2014; 33(2):78-81.
[26] Gélinas C, Fillion L, Puntillo KA, Viens C, et al. Validation of the critical-care pain observation tool in adult patients. Am J Crit Care. 2006; 15(4):420-7.
[27] Rouhalamini A, Fallahzadeh H, Nasiriani K. Comparing the Persian version properties of Behavioral Pain Scale and Critical Care Pain Observation Tool in patients with head trauma. koomesh. 2021; 23(3):e149953.
[28] Komlakh K, Hatefi M, Soltany B. Comparison of Pain Score in Patients with Brain Disorders Using Care Pain Observation Tool (CPOT) and Nonverbal Pain Scale (NVPS). Arch Neurosci. 2022; 9(4):e123099.
[29] Gomarverdi S, Sedighie L, Seifrabiei MA, Nikooseresht M. Comparison of Two Pain Scales: Behavioral Pain Scale and Critical-care Pain Observation Tool During Invasive and Noninvasive Procedures in Intensive Care Unit-admitted Patients. Iran J Nurs Midwifery Res. 2019; 24(2):151-155.
[30] Kiavar M, Azarfarin R, Totonchi Z, Tavakoli F, et al. Comparison of Two Pain Assessment Tools, "Facial Expression" and "Critical Care Pain Observation Tool" in Intubated Patients After Cardiac Surgery. Anesth Pain Med. 2016; 6(1):e33434.
[31] Khanna P, Pandey RK, Chandralekha C, Sharma A, et al. Comparison between Critical-Care Pain Observation Tool and physiologic indicators for pain assessment in the critically ill, mechanically ventilated adult patients. Saudi J Anaesth. 2018; 12(3):384-388.
[32] Modanloo M, Mohsenpour A, Rahmani H, Moghaddam S, et al. Impact of Implementing the Critical Care Pain Observation Tool on Nurses' Performance in Assessing and Managing Pain in the Critically Ill Patients. Indian J Crit Care Med. 2019; 23(4):165-169.
[33] Sedighi L, Mollai Z, Ahmadi M, Hosseini M, et al. The Effect of Using Behavioral Pain Scale (BPS) by Nurses on Diagnosis of Pain and Relief Care in ICU Patients. Avicenna J Nurs Midwifery Care. 2019; 27(4):260-8.
[34] Aïssaoui Y, Zeggwagh AA, Zekraoui A, Abidi K, et al. Validation of a behavioral pain scale in critically ill, sedated, and mechanically ventilated patients. Anesth Analg. 2005; 101(5):1470-1476.
[2] Abdelmalik M, Rahama E, Abbakr I, Hamed A, et al. Nurses’ Awareness and Practice Toward Pain Assessment and Management as Fifth Vital Sign in Sudan: A Cross-sectional Study. SJMS. 2024; 19(2):248-64.
[3] Khalighi E, Soufinia A, Solaimanizadeh L, Borji M, et al. Knowledge, attitudes and barriers pain management by nurses in Iran: A systematic review. Anaesth Pain & Intensive Care. 2019; 23(4):360-369.
[4] Hatefi M, Abdi A, Tarjoman A, Borji M. Prevalence of depression and pain among patients with spinal cord injury in Iran: A systematic review and meta-analysis. Trauma Mon. 2019; 24(4):1-8.
[5] Hatefi M, Abdi A, Tarjoman A, Borji M. Investigating the Prevalence of Musculoskeletal Pain Among Iranian Children and Adolescents: A Systematic Review and Meta-Analysis. J Pediatr Rev. 2019; 7(4):191-198.
[6] Komlakh K, Karbasfrushan A. The effect of Pregabalin on the pain status of patients with disc and spinal surgeries: A systematic review of drug therapy. J Med Pharm Chem Res. 2022; 4(11):1147-1155.
[7] Determann RM, Royakkers A, Wolthuis EK, Vlaar AP, et al. Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial. Critical Care. 2010; 14(1):R1.
[8] Khayer F, Ghafari S, Saghaei M, Yazdannik A, et al. Effects of Open and Closed Tracheal Suctioning on Pain in Mechanically Ventilated Patients. Iran J Nurs Midwifery Res. 2020; 25(5):426-430.
[9] Caparros AC. Mechanical ventilation and the role of saline instillation in suctioning adult intensive care unit patients: an evidence-based practice review. Dimens Crit Care Nurs. 2014; 33(4):246-53.
[10] Kabes AM, Graves JK, Norris J. Further validation of the nonverbal pain scale in intensive care patients. Crit Care Nurse. 2009; 29(1):59-66.
[11] Payen JF, Bosson JL, Chanques G, Mantz J, et al. Pain assessment is associated with decreased duration of mechanical ventilation in the intensive care unit: a post Hoc analysis of the DOLOREA study. Anesthesiology. 2009; 111(6):1308-16.
[12] Correya A, Rawson H, Ockerby C, Hutchinson AM. Nurses' perceptions of patient pain, delirium, and sedation assessments in the intensive care unit: A qualitative study. Aust Crit Care. 2025; 38(1):101076.
[13] Abrahams Simbeye J, Sharifi F, Navab E, Bahramnezhad F. Investigating Nurses’ Knowledge, Attitude, and Performance Regarding Pain Management of Non-verbal Critically-Ill Patients in Tanzania Intensive Care Units. JCCNC. 2024; 10(1):25-34.
[14] Alotni M, Guilhermino M, Duff J, Sim J. Barriers to nurse-led pain management for adult patients in intensive care units: An integrative review. Aust Crit Care. 2023; 36(5):855-862.
[15] Abdalrahim MS, Hamdan KM, Shaheen AM. Importance of preemptive analgesia and pain assessment as perceived by intensive care unit nurses. Br J Pain. 2023; 17(4):400-407.
[16] Shahiri TS, Gélinas C. The Validity of Vital Signs for Pain Assessment in Critically Ill Adults: A Narrative Review. Pain Manag Nurs. 2023; 24(3):318-328.
[17] Gomez RJ, Barrowman N, Elia S, Manias E, et al. Establishing intra- and inter-rater agreement of the Face, Legs, Activity, Cry, Consolability scale for evaluating pain in toddlers during immunization. Pain Res Manag. 2013; 18(6):e124-8.
[18] Rijkenberg S, van der Voort PH. Can the critical-care pain observation tool (CPOT) be used to assess pain in delirious ICU patients? J Thorac Dis. 2016; 8(5):E285-7.
[19] Kelly MA, Slatyer S, Tutticci N, Ramsbotham J, et al. Challenging the nuances of pain assessment with co-designed audio-visual simulations in nursing education: A descriptive study. Clin Simulation Nurs. 2024; 87:101510.
[20] Larson S, Laures E, Seo M, Cox M, et al. Evidence-Based Pain Assessment in Nonverbal Palliative Care Patients. Pain Manag Nurs. 2024; 25(2):152-159.
[21] Taghinezhad F, Raiesifar A, Taghinezhad Y, Mohammadi E. Professional Quality of Life among Iranian Clinical Nurses at the Forefront of the Fight against COVID-19: A Multicenter Cross-Sectional Study. Iran J Nurs Midwifery Res. 2024; 29(2):187-193.
[22] Taghinezhad F, Safavi M, Raiesifar A, Yahyavi SH. Antecedents of organizational citizenship behavior among Iranian nurses: a multicenter study. BMC Res Notes. 2015; 8:547.
[23] Wong DL, Baker CM. Wong-Baker faces pain rating scale. Pain Manag Nurs. 2012.
[24] Nazari R, Sharifnia H, Mousazadeh N, Hasani A. Validation of the Persian Version of Critical Care Pain Observation Tool. JCC Nursing. 2021; 14(3):51-59.
[25] Buttes P, Keal G, Cronin SN, Stocks L, et al. Validation of the critical-care pain observation tool in adult critically ill patients. Dimens Crit Care Nurs. 2014; 33(2):78-81.
[26] Gélinas C, Fillion L, Puntillo KA, Viens C, et al. Validation of the critical-care pain observation tool in adult patients. Am J Crit Care. 2006; 15(4):420-7.
[27] Rouhalamini A, Fallahzadeh H, Nasiriani K. Comparing the Persian version properties of Behavioral Pain Scale and Critical Care Pain Observation Tool in patients with head trauma. koomesh. 2021; 23(3):e149953.
[28] Komlakh K, Hatefi M, Soltany B. Comparison of Pain Score in Patients with Brain Disorders Using Care Pain Observation Tool (CPOT) and Nonverbal Pain Scale (NVPS). Arch Neurosci. 2022; 9(4):e123099.
[29] Gomarverdi S, Sedighie L, Seifrabiei MA, Nikooseresht M. Comparison of Two Pain Scales: Behavioral Pain Scale and Critical-care Pain Observation Tool During Invasive and Noninvasive Procedures in Intensive Care Unit-admitted Patients. Iran J Nurs Midwifery Res. 2019; 24(2):151-155.
[30] Kiavar M, Azarfarin R, Totonchi Z, Tavakoli F, et al. Comparison of Two Pain Assessment Tools, "Facial Expression" and "Critical Care Pain Observation Tool" in Intubated Patients After Cardiac Surgery. Anesth Pain Med. 2016; 6(1):e33434.
[31] Khanna P, Pandey RK, Chandralekha C, Sharma A, et al. Comparison between Critical-Care Pain Observation Tool and physiologic indicators for pain assessment in the critically ill, mechanically ventilated adult patients. Saudi J Anaesth. 2018; 12(3):384-388.
[32] Modanloo M, Mohsenpour A, Rahmani H, Moghaddam S, et al. Impact of Implementing the Critical Care Pain Observation Tool on Nurses' Performance in Assessing and Managing Pain in the Critically Ill Patients. Indian J Crit Care Med. 2019; 23(4):165-169.
[33] Sedighi L, Mollai Z, Ahmadi M, Hosseini M, et al. The Effect of Using Behavioral Pain Scale (BPS) by Nurses on Diagnosis of Pain and Relief Care in ICU Patients. Avicenna J Nurs Midwifery Care. 2019; 27(4):260-8.
[34] Aïssaoui Y, Zeggwagh AA, Zekraoui A, Abidi K, et al. Validation of a behavioral pain scale in critically ill, sedated, and mechanically ventilated patients. Anesth Analg. 2005; 101(5):1470-1476.
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How to Cite
1.
Sarafi M, Esmaeilian S, Borji M, Vasigh A, Ebrahimisaraj G. Comparison of Behavioral Pain Scale and Critical Care Pain Observation Tool in Pain Score of Trauma Patients in Intensive Care Units. Arch Anesth & Crit Care. 2026;.
