Prospective studies confirm that the majority of patients who are treated in ICUs
have pain,1 which makes the assessment of pain and provision of adequate analgesia
essential components of ICU care. The short-term consequences of untreated
pain include higher energy expenditure and immunomodulation.2,3 Longer-term,
untreated pain increases the risk of post-traumatic stress disorder.4 Assessing
whether a patient in the ICU is in pain may be difficult. The reference standard for
the assessment of pain is self-reporting by the patient, but patients in the ICU may
not be sufficiently interactive to give valid responses. Physiological indicators such
as hypertension and tachycardia correlate poorly with more intuitively valid measures
of pain,5 but pain scales such as the Behavioral Pain Scale6 and the Critical Care Pain Observation Tool7 provide structured
and repeatable assessments and are currently the
best available methods for assessing pain