Unveiling Pain in the ICU: A Head-to-head Comparison of BPS and CPOT in Mechanically Ventilated Patients

Background: Accurate pain evaluation in critically ill patients poses significant challenges, particularly when these patients are unable to communicate their experiences. The objective of the study was to evaluate the accuracy and interrater reliability of the Behavioural Pain Scale (BPS) and Critical Care Pain Observation Tool (CPOT) in pain assessment among patients on mechanical ventilator support. Methods and Materials: Twenty-six patients on mechanical ventilation in a tertiary care intensive care unit (ICU) were included in this cross-sectional study, and the level of pain was assessed at different states, such as during rest, positioning and suctioning, using both tools. The data was analysed using SPSS 20→ software. Results: Receiver Operating Characteristic (ROC) curve analysis showed that BPS and CPOT are equally sensitive during rest (0.488 vs. 0.473) and suctioning (0.581 vs. 0.57), while CPOT is more sensitive during positioning (0.687 vs. 0.575). However, BPS and CPOT are equally sensitive during rest with a high positive correlation and a moderate correlation during active procedures such as positioning and suctioning ( P < .001). Conclusion: These findings conclude that pain assessment in mechanically ventilated patients is challenging. BPS and CPOT are equally reliable at a moderate level for pain assessment during rest and active interventions like suctioning and positioning. The study emphasises the need for targeted training and standardised criteria to improve interrater reliability, particularly during dynamic procedures, to enhance pain management in critically ill patients.