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    Chief Complaint


    Organ System


    Patent Pending

    Behavioral Pain Scale (BPS) for Pain Assessment in Intubated Patients

    Quantifies pain in intubated patients.


    One can also use the Nonverbal Pain Scale (NVPS) for Nonverbal Patients as an alternative to the BPS.
    When to Use
    Why Use

    Intubated patients, often undergoing painful procedures.

    • The Behavioral Pain Scale (BPS) quantifies pain using body language and patient-ventilator interactions for intubated patients.
    • It was developed and validated by performing non-painful procedures (i.e., a central line dressing change) and noxious procedures (i.e., endotracheal tube suctioning) and then observing response patterns.

    Nonverbal patients express pain variably, making a standardized, accurate tool helpful in the evaluation of pain. Pain can be a cause of abnormal vital signs in the ICU setting, and using a quantitative tool can help confirm or refute this hypothesis.

    Partially tightened (e.g., brow lowering)
    Fully tightened (e.g., eyelid closing)
    No movement
    Partially bent
    Fully bent with finger flexion
    Permanently retracted
    Tolerating movement
    Coughing but tolerating ventilation for most of the time
    Fighting ventilator
    Unable to control ventilation


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    Next Steps
    Creator Insights


    The BPS is a useful tool to assess pain in intubated patients.

    Critical Actions

    The BPS requires attentive clinical observation and examination.


    Addition of assigned points.

    Facts & Figures

    Score interpretation:

    • Scores ≤3 indicate no pain.
    • Scores 4-5 indicate mild pain.
    • Scores 6-11 indicate an unacceptable amount of pain.*
    • Scores ≥12 indicate maximum pain.*

    *Note: For scores ≥6 consider sedation and/or analgesia.

    Dr. Jean-François Payen

    About the Creator

    Jean-François Payen, MD, is a professor of anesthesia resuscitation and head of the anesthesiology department at the Grenoble University Hospital in France. He is also the director of the European Committee Site of Education in Anesthesiology. Dr. Payen is an active researcher investigating traumatic brain injuries through detailed imaging and pharmacological neuroprotective mechanisms.

    To view Dr. Jean-François Payen's publications, visit PubMed

    About the Creator
    Dr. Jean-François Payen