Development of a Pain Assessment Measure for Severe Brain Injury

Conditions causing pain are common after traumatic brain injury, but many patients with moderate/severe brain injury are unable to cooperate with typical pain assessment procedures that require identifying the location of pain and numerically grading its severity. This may result in excessive diagnostic procedures to search for a source of pain and either under or over-treating pain in the absence of any objective measure of its severity. This project, a collaboration among investigators at the Moss TBIMS, Glostrup Hospital in Copenhagen, DK, and the Boston Rehabilitation Outcomes Center, will develop and validate an observational pain measure that can be completed by nurses and other caregivers. Each participant will be observed and rated during 8 15-minute intervals on 2 days, while engaged in a range of activities and while taking a range of analgesic doses. Participants’ level of consciousness and agitation will also be measured. The initial observational tool will be shortened and refined using modern test theory. Validation will involve comparing scores among those with and without known causes of pain, on larger and smaller doses of analgesics, and during activities expected to produce more and less pain.