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"This study will help us identify what we mean when we say a patient is grimacing, frowning or making an expression that would indicate pain. What I say is a grimace and what you think is a grimace may be very different, but if you say the brow is raised, and that's an indicator of pain, it is much more objective. I believe this will radically affect the fi eld in terms of the tools we use to evaluate patients in pain." — Mary Jo Grap, PhD, RN, FAAN, Nursing Alumni Distinguished Professor at Virginia Commonwealth University and co-author of the facial expression study signifi cantly elevated in number from baseline to the endotracheal suctioning procedure. Results of a stepwise multivariate analysis of the 14 elevated AUs revealed that fi ve AUs were most strongly activated during painful stimuli. These included a raising of the inner brow; lowering of the eyebrow; nose wrinkling; turning the head to the right; and moving the head upward and backward. The strongest response during pain was a combination of three AUs that included lowering of the eyebrows and tightening of the orbit muscles around the eyes. While results are promising and indicate that looking for these specifi c facial expressions may help nurses more reliably evaluate pain levels, Arif-Rahu notes one study limitation. Due to the tubes in the mouths and noses of the subjects, as well as related securing devices, she was able to objectively view only upper facial movements around the eyes. Moving forward, she plans to study patients who are not intubated to look for similarities and differences. She also hopes to measure the intensity of the muscle response based on electromyographical analysis in individuals whose faces are not obscured by tubes and securing devices. ■ THE MULTIDIMENSIONAL OBJECTIVE Pain Assessment Tool (MOPAT) allows nurses who work with noncommunicative patients to more easily measure behavioral and physiologi- cal pain responses. The four behaviors measured using the MOPAT — muscular tension, restlessness, grimacing and patient sounds — were adapted from the Post Anesthesia Care Unit Behavioral Pain Rating Scale using information obtained during focus groups with hospice nurses. Researchers seeking to develop and test the MOPAT methodology conducted these focus groups as part of a four-part study, the results of which were published in the March 2011 issue of the Journal of Palliative Medicine. Currently, this team of researchers is exploring broader applications for the MOPAT methodology, testing it in both an acute-care hospital and an inpatient hospice unit. Preliminary results suggest the MOPAT is an important pain evaluation tool in both care settings. "The MOPAT is a reliable, valid and clinically useful tool to assess pain in a highly vulnerable population," says Deborah B. McGuire, PhD, RN, FAAN, Associate Dean for Research and Florence E. Elliot Professor at the Virginia Commonwealth University School of Nursing, and lead author of the MOPAT study. "If we can demonstrate in our ongoing study that it is easily incorporated into a pain management algorithm and that it contributes to better outcomes and better management of pain, it is well worth putting into practice as an objective measure of pain in patients we have long been unable to assess appropriately." Bringing Pain Assessment Tools Bedside M D N E W S . CO M ■ MD NEWS Long Island | 1 5

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