Comparative Accuracy of Critical Care Pain Observation Tool (CPOT), Behavioral Pain Scale (BPS), and Non-verbal Pain Scale (NVPS) for Pain Assessment in Mechanically Ventilated Intensive Care Unit Patients: A Prospective Observational Study

Derlin Thomas; Anoob J Kuruppasseril; Rahmath A Samad; Edwin J George

doi:10.5005/jp-journals-10071-24984

Comparative Accuracy of Critical Care Pain Observation Tool (CPOT), Behavioral Pain Scale (BPS), and Non-verbal Pain Scale (NVPS) for Pain Assessment in Mechanically Ventilated Intensive Care Unit Patients: A Prospective Observational Study

Indian J Crit Care Med. 2025 Jun;29(6):492-497. doi: 10.5005/jp-journals-10071-24984. Epub 2025 Jun 5.

Authors

Derlin Thomas¹, Anoob J Kuruppasseril², Rahmath A Samad¹, Edwin J George³

Affiliations

¹ Department of Anaesthesiology, Amala Institute of Medical Sciences, Thrissur, Kerala, India.
² Department of Gastroenterology, Amala Institute of Medical Sciences, Thrissur, Kerala, India.
³ Department of Medicine, Amala Institute of Medical Sciences, Thrissur, Kerala, India.

Abstract

Aim and background: Evaluating pain in critically ill patients on mechanical ventilation poses a unique clinical challenge, mainly because of their inability to self-report. Hence, our study aimed to compare the effectiveness of the critical care pain observation tool (CPOT) and the behavioral pain scale (BPS) in these patients. Additionally, we determined their individual and combined accuracy against the nonverbal pain scale (NVPS) and examined their correlation with physiological indicators, specifically heart rate (HR) and blood pressure (BP).

Patients and methods: Fifty mechanically ventilated patients were enrolled, with eight subsequently dropping out. Sedation was maintained using morphine and midazolam infusions, targeting a Ramsay Sedation Score above 3. Pain evaluation with CPOT, BPS, and NVPS were done at rest and during two painful stimuli: tracheal suctioning and patient repositioning, along with HR and BP measurements. Data were collected at four time points: At rest, during suctioning, post-repositioning, and finally again at rest.

Results: Combined CPOT and BPS displayed superior diagnostic performance, showing the highest sensitivity (0.88), specificity (0.85), and AUC (0.87). Individually, both BPS (sensitivity 0.85, specificity 0.80) and CPOT (sensitivity 0.83, specificity 0.82) showed considerable accuracy, while NVPS (sensitivity 0.80, specificity 0.78) revealed comparatively lower sensitivity and specificity.

Conclusion: The combined use of CPOT and BPS offers the most reliable method for assessing pain in ventilated ICU patients. Even though NVPS can be an ancillary tool, a multimodal pain assessment strategy ensures optimal patient comfort and care.

How to cite this article: Thomas D, Kuruppasseril AJ, Samad RA, George EJ. Comparative Accuracy of Critical Care Pain Observation Tool (CPOT), Behavioral Pain Scale (BPS), and Non-verbal Pain Scale (NVPS) for Pain Assessment in Mechanically Ventilated Intensive Care Unit Patients: A Prospective Observational Study. Indian J Crit Care Med 2025;29(6):492-497.

Keywords: Critical illness; Intensive care units; Mechanical ventilation; Pain assessment behavioral pain scale.