Why did you develop the Behavioral Pain Scale? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?
I decided to create this clinical instrument because nurses in my intensive care unit (ICU) complained about the lack of medical interest toward pain in sedated, non-verbal patients. We thus started with an instrument to assess pain (or nociception) for these patients.
What pearls, pitfalls and/or tips do you have for users of the Behavioral Pain Scale? Do you know of cases when it has been applied, interpreted, or used inappropriately?
The BPS should be used at rest and during a noxious stimulus, e.g. endotracheal suctioning, turning, mobilization.
To be sure that BPS scoring is well done by different raters, the whole description of the items should be easily accessible, e.g. on a panel present in each ICU room.
It is useless to assess pain too frequently, i.e., every hour. Usually, it is enough to assess pain once per shift (8 hours) plus every time the analgesia is changed.
What recommendations do you have for doctors once they have applied the Behavioral Pain Scale? Are there any adjustments or updates you would make to the score based on new data or practice changes?
It is critical to establish a dialog between doctors and nurses in the ICU about pain and sedation, in order to write a local protocol describing which clinical instruments should be used for assessment, the targets to reach for optimal analgesia and sedation, the choice of drugs available in the ICU, and an algorithm to adjust doses according to the results of this evaluation.
Any other research in the pipeline that you're particularly excited about?
A more quantitative approach to assess nociception in non-verbal ICU patients could be reached with the analysis of pupil size changes in response to standardized noxious stimulation. This quantitative pupillometry is an infrared videopupillometer equipped with a tetanic stimulator.
