How is the CPOT scored and what threshold indicates pain?

CPOT scores four indicators: Facial expression (0–2: relaxed/neutral, tense/frowning, grimacing). Body movements (0–2: absence of movement, protection, restlessness). Muscle tension (0–2: relaxed, tense/rigid, very tense/rigid). Compliance with ventilator or vocalization (0–2: tolerating/no sound, coughing/moaning, fighting/crying). Total score 0–8; a score ≥2 indicates significant pain. In meta-analyses, a threshold of ≥2 shows sensitivity 0.74 and specificity 0.73 for nociceptive procedures.

When should pain assessment be performed in ICU patients?

SCCM PADIS guidelines recommend routine pain assessment every 2–4 hours and before and after painful procedures (suctioning, repositioning, line insertion, dressing changes). Pain assessment should precede sedation titration — the 'analgesia-first' approach (analgosedation) uses an opioid-based strategy to treat pain before adding sedatives, reducing overall sedative requirements and improving patient outcomes.

Critical-Care Pain Observation Tool (CPOT)

Assess pain in non-verbal ICU patients using the CPOT, which scores facial expression, body movements, muscle tension, vocalization, and ventilator compliance (0–8).

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Frequently Asked Questions

How is the CPOT scored and what threshold indicates pain?

When should pain assessment be performed in ICU patients?