Health Check: Measuring pain in patients who can't communicate

Sandra Linde used to provide direct care as a nurse. As a researcher now at Rhode Island Hospital, she wanted to know the best way to measure pain in patients who were unable to speak for themselves.

She and colleagues poured over critical care pain observations tools -- CPOTs -- and decided to put one that's already out there to the test.

"We picked this one because of the ventilator component," Linde said of the pain observation chart that was developed in Canada a few years ago.

"We were looking for two things: does this CPOT measure pain? So that's the validity. And do two raters get the same score?" she said.

Linde and her team looked at 30 cardiac patients who agreed to take part in the study.

"They were right after surgery, still under anesthesia, waking up from anesthesia on a ventilator and sedated," she said.

What signs were they looking for that might indicate pain?

"You're looking at facial expressions, body movements, overall comfort with the ventilator," Linde said.

But does it matter if the patient doesn't remember the pain?

"Research shows there are better outcomes when pain is managed appropriately because there are adverse outcomes and you can be on a ventilator longer if your pain isn't managed appropriately," Linde said.

Post-surgery, before they wake up, patients routinely have both painful and non-painful procedures. Turning a patient is considered painful. Changing a dressing is not.

Using the chart, the team of nurses rated pain. A biostatistician analyzed the data and determined the results were statistically significant.

"That it did measure pain, the scores went up with the painful procedure using this tool and that the nurses did get the same scores when they didn't know of each other's scores," Linde said.

The results of Linde's study have been published in the American Journal of Critical Care.

This is the first study conducted in Rhode Island Hospital's clinical nurse scholar program, where direct care nurses are mentored to serve as principal investigators. Linde is now one.

As a result of this study, this pain tool will be implemented in all of Lifespan's intensive care units. The goal is to ensure patients who are unable to communicate to have a pain score of zero, which is no pain.