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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
    Dr. Jean-François Payen

    From the Creator

    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.

    About the Creator

    Jean-François Payen, MD, PhD, is a professor of anesthesia and critical care medicine and head of the anesthesiology and critical care department at the Grenoble Alpes 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

    Are you Dr. Jean-François Payen? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    About the Creator
    Dr. Jean-François Payen
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