Adult critical care patients who are unable to self-report their pain (e.g., mechanically ventilated, altered mental status).

Post-operative ICU pain tracking.

Assessing pain prior to, during, and after a known nociceptive procedure (e.g., turning, suctioning, line placement).

Facial Expression (0-2)

Body Movements (0-2)

Muscle Tension (0-2, evaluated via passive flexion of arm)

Compliance with Ventilator OR Vocalization if Extubated (0-2)

Always attempt self-report (e.g., nodding or pointing to a scale) before relying on observational tools.

Observe the patient for one minute at rest to establish a baseline, then assess during a nociceptive procedure (like turning) to detect changes.

Muscle tension is arguably the most sensitive indicator. If the arm resists passive flexion, suspect pain.

CPOT > 2: High probability of pain. Consider administering analgesia depending on hemodynamic stability.

0-2: Pain unlikely, but does not absolutely rule out discomfort. Use clinical judgment.