Eye-tracking enables reliable pain assessment in intubated SCI patients and is not associated with self-appraisals.

AIMS: To examine whether eye-tracking (ET) enables reliable self-report of pain in intubated patients with spinal cord injury (SCI) and to explore associations between pain and psychological self-appraisals. METHODS: In this prospective observational study, 75 mechanically ventilated ICU patients (46 SCI, 29 non-SCI) completed pain assessments using a Tobii Dynavox ET device. Pain was measured via the Numeric Rating Scale (NRS) and the EQ-5D-5L pain dimension. Self-esteem, anxiety, and depression were measured with the Visual Analogue Self-Esteem Scale (VASES). RESULTS: NRS and EQ-5D pain ratings showed strong correlation (r = 0.78, p < 0.001). Pain intensity did not differ significantly between SCI and non-SCI groups. No significant associations were observed between pain and self-esteem, anxiety, or depression. A Bland - Altman plot confirmed agreement between NRS and EQ-5D pain scores. CONCLUSIONS: ET enables reliable pain self-report in intubated ICU patients with severely limited communication. Pain ratings were independent of psychological self-appraisals, suggesting ET offers a feasible, patient-centered tool for assessing pain in this population.