We read with interest the excellent paper “Observational Pain Scales in Critically Ill Adults”1  in the June 2013 issue. Stites found that the Critical-Care Pain Observation Tool (CPOT) is the best available scale to assess pain in these patients. This finding confirms the results of a recent comparative analysis on several behavioral pain scales for intensive care unit (ICU) patients.2  The CPOT and the Behavioral Pain Scale (BPS) are the most valid and reliable tools among pain scales for adult ICU patients. However, the CPOT needs to be widely studied in nonintubated ICU patients unable to self-report and in brain injured patients, and the BPS has problems in the interpretation of some items due to ambiguities or scarce clarity in definitions.2 

We would like to bring up some critical points regarding these scales. First, the CPOT and the BPS do not have a specific item for patients...

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