Sanitas

Revista arbitrada de ciencias de la salud

Vol. 3(1), 17-23, 2024

https://doi.org/10.5281/zenodo.10614171

Comprehensive perspective on pain assessment and management

Perspectiva integral sobre la evaluación y manejo del dolor

Mario Fernando Rivera-Escobar

pg.mariofre77@uniandes.edu.ec

Universidad Regional Autónoma de los Andes, Ambato, Tungurahua,

Ecuador

https://orcid.org/0000-0001-6878-2756

ABSTRACT

Objective: to analyse the integral perspective on the assessment and management of pain. Method:

descriptive documentary type. Results and conclusion: As progress is made in the understanding

and management of pain in critical care settings, it is essential to consider not only the clinical efficacy

of the scales, but also their practical and ethical feasibility. The continued search for improved

assessment tools tailored to the specific needs of non-communicative critically ill patients remains a

priority to improve the quality of care and ensure effective pain relief in these challenging clinical

settings.

Descriptors: intensive care units; low back pain; nurse-patient relations. (Source, DeCS).

RESUMEN

Objetivo: analizar la perspectiva integral sobre la evaluación y manejo del dolor. Método: De tipo

descriptivo documental. Resultados y conclusión: A medida que se avanza en la comprensión y

gestión del dolor en entornos críticos, es esencial considerar no solo la eficacia clínica de las escalas,

sino también su viabilidad práctica y ética. La búsqueda continua de herramientas de evaluación

mejoradas y adaptadas a las necesidades específicas de los pacientes críticos no comunicativos

sigue siendo una prioridad para mejorar la calidad de la atención y garantizar un alivio efectivo del

dolor en estos contextos clínicos desafiantes.

Descriptores: unidades de cuidados intensivos; dolor lumbar; relaciones enfermera-paciente.

(Fuente, DeCS).

Received: 09/09/2023. Revised: 16/09/2023. Approved: 19/10/2023. Published: 01/01/2024.

Original in brief

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 3(1), 17-23, 2024

Perspectiva integral sobre la evaluación y manejo del dolor

Comprehensive perspective on pain assessment and management

Mario Fernando Rivera-Escobar

INTRODUCTION

The provision of medical care, understanding and management of pain are

fundamental pillars in ensuring the overall health of patients. In particular, pain

management in those undergoing invasive mechanical ventilation presents a highly

complex challenge that demands a comprehensive and thorough approach.

1 2 3

This introduction dives into the fascinating field of pain assessment and

management, exploring the various dimensions that encompass this clinical

experience. From the consideration of specialised pain scales to the application of

more advanced intervention strategies, a journey will be undertaken towards an in-

depth understanding of how to mitigate suffering in patients connected to invasive

mechanical ventilation systems.

Throughout this analysis, it will unravel not only the biological and physiological

complexities related to pain, but also the emotional and psychological implications

that affect the patient's perception and response. Ultimately, this holistic perspective

seeks to illuminate the importance of medical care that not only prolongs life, but

also promotes quality of life by addressing pain as an essential component in the

pursuit of holistic health.

The aim is to analyse the holistic perspective on pain assessment and management.

METHOD

A descriptive documentary bibliographic research was carried out with an analytical-

synthetic approach to address ethical considerations in the management of pain in

patients undergoing invasive mechanical ventilation.

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 3(1), 17-23, 2024

Perspectiva integral sobre la evaluación y manejo del dolor

Comprehensive perspective on pain assessment and management

Mario Fernando Rivera-Escobar

The study population consisted of 15 scientific articles selected from prominent

databases, such as PubMed and Scielo, specifically addressing pain management

in this clinical context.

In the descriptive phase, the identified articles were comprehensively collected and

reviewed, assessing their objectives, methodologies used, results obtained and

conclusions. Particular attention was paid to the interventions and strategies applied

in pain management, as well as the ethical considerations inherent in these

approaches.

Subsequently, in the analytical stage, comparisons were made between the different

approaches proposed in the selected studies, highlighting similarities and

differences in terms of efficacy, safety and ethical aspects. A synthetic analysis was

used to integrate the findings and provide a comprehensive view of the ethical

strategies adopted in the management of pain in patients with invasive mechanical

ventilation.

It should be noted that throughout the process, ethical considerations were taken

into account, ensuring confidentiality and respect for the authors of the reviewed

articles. In addition, the ethical use of the information collected was guaranteed,

respecting the fundamental principles of scientific research.

RESULTS

In the context of pain assessment in critically ill patients, the implementation of the

Critical Care Pain Observation Scale (CPOT) is presented as a crucial tool to assess

pain in those individuals who cannot express themselves verbally. However, like the

Behavioural Pain Scale (BPS), the CPOT has limitations in its application, especially

in patients under sedoanalgesia, treatment with neuromuscular relaxants,

tetraplegia or polyneuropathy.

4 5 6

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 3(1), 17-23, 2024

Perspectiva integral sobre la evaluación y manejo del dolor

Comprehensive perspective on pain assessment and management

Mario Fernando Rivera-Escobar

In the analysis of its application, it is observed that the CPOT incorporates elements

of pre-existing scales, including the BPS, by integrating four behavioural items: facial

expression, body movements, muscle tension and adaptation to the ventilator in

intubated patients, or vocalisation in extubated patients. On the other hand, the Pain

Indicating Behaviours Scale (PIDS) focuses on facial expression, calmness

(movements), muscle tone, comfort and adaptation to mechanical ventilation. A

distinguishing feature of the ESCID from the original Campbell scale is its inclusion

of the patient's verbal response rather than adaptation to mechanical ventilation,

which makes it more suitable for non-ventilated patients.

6 7 8

It is noted that the BPS scale, designed specifically for the assessment of non-

communicative patients in critical settings, has the highest reliability compared to

other scales. This reliability is supported by its three core items: facial expression,

upper limb movement and adaptation to mechanical ventilation. Through various

investigations, its robustness in the detection and measurement of pain in critically

ill patients has been confirmed, consolidating it as a reliable and valid tool.

9 10

The choice between the different scales for pain assessment in critically ill patients

should be based on the specific nature of the population studied and the particular

clinical conditions. While the CPOT and ESCID are useful in certain contexts, the

BPS proves to be the most reliable and validated option for the assessment of non-

communicative patients in critical care settings.

11 12

In addition, two scales stand out, the Critical-Care Pain Observation Tool (CPOT)

and the Pain Indicator Behaviour Scale (ESCID), both of which have limitations,

especially in patients with sedoanalgesia or mechanical ventilation.

The CPOT, like the Behavioural Pain Scale (BPS), uses items from existing scales

and assesses facial expression, body movements, muscle tension and adaptation

to the ventilator or vocalisation. On the other hand, the ESCID differs by considering

the patient's verbal response rather than adaptation to mechanical ventilation.

14 15

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 3(1), 17-23, 2024

Perspectiva integral sobre la evaluación y manejo del dolor

Comprehensive perspective on pain assessment and management

Mario Fernando Rivera-Escobar

The BPS, designed specifically for non-communicative patients in critical settings, is

notable for its reliability and validity, supported by three key items: facial expression,

upper limb movement and adaptation to mechanical ventilation. The choice of scale

should be based on the nature of the population and clinical conditions, recognising

that the BPS is the most robust option for pain assessment in non-communicative

critically ill patients.

CONCLUSION

Pain assessment in critically ill patients poses significant challenges, especially in

those who are unable to express their discomfort verbally. Although tools such as

the CPOT and ESCID offer valuable approaches, each has specific limitations, such

as their applicability in patients under sedoanalgesia or mechanical ventilation.

The BPS scale stands out as the most reliable and validated option, focusing on

crucial aspects such as facial expression, upper limb movements and adaptation to

mechanical ventilation. This preference is supported by the robustness of its design,

specifically created to address the complexity of assessing pain in non-

communicative critically ill patients.

As progress is made in the understanding and management of pain in critical care

settings, it is essential to consider not only the clinical efficacy of the scales, but also

their practical and ethical feasibility. The continued search for improved assessment

tools tailored to the specific needs of non-communicative critically ill patients remains

a priority to improve the quality of care and ensure effective pain relief in these

challenging clinical settings.

FUNDING

Non-monetary

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 3(1), 17-23, 2024

Perspectiva integral sobre la evaluación y manejo del dolor

Comprehensive perspective on pain assessment and management

Mario Fernando Rivera-Escobar

CONFLICT OF INTEREST

There is no conflict of interest with individuals or institutions involved in the research.

ACKNOWLEDGEMENTS

To patients in pain for finding ways for their recovery.

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Revista arbitrada de ciencias de la salud

Vol. 3(1), 17-23, 2024

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Comprehensive perspective on pain assessment and management

Mario Fernando Rivera-Escobar

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