Issue link: https://viewer.e-digitaledition.com/i/425939
W HILE PREPARING FOR her doctoral dissertation, Mamoona Arif-Rahu, PhD, RN, CCRN, Clinical Nurse Specialist in critical care at Virginia Commonwealth University Medical Center and lead author of the study, began looking at ways to better assess pain levels in sedated, comatose individuals on mechanical ventilation. Her research led her to the Facial Action Coding System, developed in the 1970s by Paul Ekman, PhD, Professor Emeritus in Psychology at the University of California, San Francisco. "In reviewing a literature search on the best tool to use [for pain assessment], I saw a common theme in the scales, and one of them was facial expression," Arif-Rahu says. "Everyone described frowning, grimaces and relaxed expres- sions, and each tool used different ways of quantifying pain response. The Facial Action Coding System has been used in various behavioral studies, so I thought, 'Why not use it to look at facial expressions and see if we can't quantify pain in this way?'" Arif-Rahu developed a study methodology consisting of using a video camera to create recordings of the facial expressions of 50 ICU patients on mechanical ventilation. Recordings were taken both while the individuals were sleeping and during endotracheal suctioning, a routine part of nursing care that is known to cause pain. Arif-Rahu consulted with Jeffrey F. Cohn, PhD, Professor of Psychology and Psychiatry at the University of Pittsburgh and co-author of the paper in AJCC, to validate a reliable scoring system for analyzing the recordings. Once the scoring system was in place, she viewed each recording in slow motion using The Observer XT software to code the videos in real time. Analyzing the Results Of the 44 facial action units (AUs) coded during Arif-Rahu's analysis, 14 were Written on Their Faces: Assessing Pain in Noncommunicative Patients By Tiffany Parnell NO GOLD STANDARD EXISTS FOR MEASURING PAIN LEVELS IN INTUBATED PATIENTS. HOWEVER, A STUDY PUBLISHED RECENTLY IN THE AMERICAN JOURNAL OF CRITICAL CARE (AJCC) REVEALS THAT THE ACTIVATION OF CERTAIN FACIAL MUSCLES MAY BE A RELIABLE INDICATOR OF PAIN IN CRITICALLY ILL PATIENTS WHO ARE UNABLE TO COMMUNICATE. 1 4 | Long Island MD NEWS ■ M D N E W S . CO M