• Shoko Yamada and Yuko Ikematsu.
• Graduate School Department of Interdisciplinary Research, University of Yamanashi, Yamanashi, Japan. Electronic address: shohkoy@yamanashi.ac.jp.
• Pain Manag Nurs. 2021 Dec 1; 22 (6): 769-774.

BackgroundCritically ill patients experience various types of pain that are difficult to assess because patients cannot communicate verbally due to artificial airways and sustained sedation. The Critical-Care Pain Observation Tool (CPOT) objectively evaluates patients' pain.AimsThis study aimed to re-assess the reliability and validity of the Japanese version (CPOT-J) and to reveal limitations of behaviors specific to mechanically ventilated patients.DesignSecondary analysis of observational pilot study and case report.Participants  METHODS: We obtained consent preoperatively from 40 cardiovascular surgery patients. CPOT-J scores were evaluated immediately before, immediately after, and 20 minutes after painful stimulation. Inter-rater reliability was determined by the researcher and 18 ICU nurses (minimum one-year ICU experience). Validity was examined by comparing CPOT-J with vital sign values and patients' self-reports of pain. Two cases revealed the tool's characteristics: one score was consistent with patient reports while the other was not.ResultsWe evaluated pain in 34 patients (26 men, 8 women; mean age = 66.8 years). Weighted kappa scores ranged from 0.48 to 0.94. The tool only correlated with changes in systolic blood pressure and pulse pressure. Case studies indicated that the tool effectively evaluated mid-sternum-wound pain, but not back pain at rest.ConclusionsThe CPOT-J can assess pain in mechanically ventilated patients, but being immobile results in a score of 0 for body movement (e.g., being immobile while feeling back pain) and is a limitation of the scoring.Copyright © 2021 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

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