This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Many intensive care patients cannot say they are in pain because they are intubated, sedated or confused. The Critical-Care Pain Observation Tool (CPOT) was developed by Céline Gélinas and colleagues in Montreal and published in 2006. Together with the Behavioral Pain Scale, it is one of the two tools recommended by the Society of Critical Care Medicine for adults who cannot self-report.
The four items
Each item scores 0 to 2.
Facial expression
- 0: relaxed, neutral
- 1: tense, with frowning, brow lowering or tightened eyes
- 2: grimacing, with eyelids tightly closed; the patient may bite the tube
Body movements
- 0: no movement or normal position
- 1: protection, with slow cautious movements or touching the painful area
- 2: restlessness, pulling at tubes, trying to sit up, not following commands
Muscle tension, judged by passive flexion and extension of the arms
- 0: relaxed
- 1: tense, rigid
- 2: very tense or rigid
Ventilator compliance for intubated patients, or vocalization for others
- 0: tolerating the ventilator, or talking normally or silent
- 1: coughing but tolerating, or sighing and moaning
- 2: fighting the ventilator, or crying out and sobbing
The total runs from 0 to 8.
Reading the score
A score above 2 suggests pain. It should lead to treatment, such as repositioning, analgesia or adjusting care, and to a new assessment after the intervention.
How to assess
Observe the patient at rest for about one minute, then during a care procedure such as turning, suctioning or wound care, and score the worst response. Assessing before, during and after painful procedures shows whether pain relief is enough.
Example
A ventilated patient who frowns (1), touches the dressing (1), resists passive movement (1) and tolerates the ventilator (0) scores 3: pain is likely.
Limits
Deep sedation and neuromuscular blockers suppress behaviors, so a low score does not prove comfort. Delirium and agitation from other causes can raise the score. The CPOT measures pain behaviors, not pain intensity; whenever the patient can communicate, even by nodding, self-report comes first.