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In the original validation study, 30 critically ill, intubated patients were divided into three groups based on sedation level: mild, moderate, or heavy. Findings from the study indicate that in each of the groups, there was a sufficient correlation with the NRS when a pain stimulus, such as a turn in bed, was performed (D'Arcy, 2006; Payen et al., 2001). The effect of the sedation was apparent, but there was still a fair correlation with the NRS, even in the group of heavily sedated patients. The tool is reliable and valid for assessing pain in this patient population. A replication study had similar results.

Thiere are other critical care pain assessment tools, such as the Gelinas Critical-Care Pain Observation Tool (CPOT), that use behavioral observation to estimate pain intensity. Although these tools are not perfected, they do provide a means of assessing pain in patients who were once thought to be unassessable.

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