1. Wiwanitkit, Viroj MD

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To the Editor:


The recent report on "dysmenor critical-care pain observation tool (CPOT) in critically ill patients" is very interesting.1 Buttes et al1 reported that "the CPOT is an acceptable behavioral pain assessment scale for use in the general critical care patient population." In fact, there are many concerns on CPOT. First, the tool still has some limitations in some scenarios. Gelinas and Johnston2 noted that it is needed to explore the value of CPOT in critically ill populations especially for those with head injuries. Second, it seems that the CPOT is a difficult-to-use tool. Gelinas et al3 also showed that communication among nurses referring to CPOT was difficult and not successful. Other comparable tool such as nonverbal pain scale might be easier to use.4 To use the CPOT, it requires special training and time to be familiar with the tool.3


Viroj Wiwanitkit, MD


Visiting Professor


Hainan Medical University, China


Faculty of Medicine


University of Nis, Serbia


Adjunct Professor


Joseph Ayobabalola University, Nigeria




1. Buttes P, Keal G, Cronin SN, Stocks L, Stout C. Validation of the critical-care pain observation tool in adult critically ill patients. Dimens Crit Care Nurs. 2014; 33 (2): 78-81. [Context Link]


2. Gelinas C, Johnston C. Pain assessment in the critically ill ventilated adult: validation of the Critical-Care Pain Observation Tool and physiologic indicators. Clin J Pain. 2007; 23 (6): 497-505. [Context Link]


3. Gelinas C, Ross M, Boitor M, Desjardins S, Vaillant F, Michaud C. Nurses' evaluations of the CPOT use at 12-month post-implementation in the intensive care unit [published online ahead of print May 9, 2014]. Nurs Crit Care. 2014. [Context Link]


4. Topolovec-Vranic J, Gelinas C, Li Y, et al. Validation and evaluation of two observational pain assessment tools in a trauma and neurosurgical intensive care unit. Pain Res Manag. 2013; 18 (6): e107-e114. [Context Link]