Clinical Calculators

CPOT (Critical-Care Pain Observation Tool)

Behavioral pain assessment in critically ill patients who cannot self-report

4 items left

Facial expression
Body movements
Muscle tension

Evaluate by passive flexion and extension of the upper limbs

Is the patient intubated?

Cautions

  • When the patient can report pain by self-report, use a numeric rating scale (NRS) or a visual analog scale (VAS). CPOT is for patients who cannot self-report (J-PAD 2014 CQ3 A3).
  • The fourth item is either compliance with the ventilator (intubated patients) or vocalization (patients who are not intubated), not both. The maximum total of 8 is the sum of facial expression, body movements, muscle tension and this one item. A patient on non-invasive ventilation is not intubated, so score vocalization.
  • For muscle tension, strong resistance to passive movement and a movement that cannot be completed are two ways of earning the same 2 points; either one is enough (Shan 2018 Table S1; the Japanese guideline table can also be read as requiring both, and the body text of the original paper was not opened).
  • Do not assess pain by vital signs alone. Even during painful procedures, a rise in blood pressure or heart rate is not a reliable indicator of the degree of pain (J-PAD 2014 CQ4 A4).
  • A body movement score of "not moving at all" does not necessarily mean that there is no pain.
  • "CPOT > 2" is given as a guide for predicting severe pain in adult ICU patients after surgery who underwent invasive procedures (J-PAD 2014).

References

  1. Gélinas C, Fillion L, Puntillo KA, Viens C, Fortier M. Validation of the Critical-Care Pain Observation Tool in adult patients. Am J Crit Care. 2006;15(4):420-427. (Full text) (original not seen) PMID: 16823021, DOI: 10.4037/ajcc2006.15.4.420[Original article]
  2. J-PAD Guideline Committee, Japanese Society of Intensive Care Medicine. Japanese clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit (J-PAD) (English title translated by the authors of this site; in Japanese). J Jpn Soc Intensive Care Med. 2014;21:539-579. (Table 4 (CPOT), CQ3 A3 and CQ4 A4 and their commentary) https://www.jsicm.org/pdf/2015-J-PAD-guideline.pdf[Guideline]
  3. Hsiung NH, Yang Y, Lee MS, Dalal K, Smith GD. Translation, adaptation, and validation of the behavioral pain scale and the critical-care pain observational tools in Taiwan. J Pain Res. 2016;9:661-669. (Table 3) PMID: 27695360, DOI: 10.2147/jpr.s91036, https://pmc.ncbi.nlm.nih.gov/articles/PMC5029847/[Review article]
  4. Shan K, Cao W, Yuan Y, et al. Use of the Critical-Care Pain Observation Tool and the bispectral index for the detection of pain in brain-injured patients undergoing mechanical ventilation: a STROBE-compliant observational study. Medicine (Baltimore). 2018;97(22). Supplemental Digital Content 1, Table S1 (description of the Critical-Care Pain Observation Tool). (Table S1) https://cdn-links.lww.com/permalink/md/c/md_2018_05_17_zhou_md-d-18-01307_sdc1.pdf[Review article]

Checked on: 2026-11-07

Disclaimer

This calculation is intended to support the judgment of healthcare professionals. Results are for reference only; decisions about diagnosis and treatment must be made by the responsible healthcare professional. The values you enter never leave your device.