The next step in this hierarchical approach is to identify diagnoses or procedures that would be considered painful in the fully conscious, verbal patient. As noted previously, many procedures associated with critical illness are painful, some more than others. It's assumed that the nonverbal patient also has pain due to these potential causes of pain. Pasero and McCaffery in 2002 introduced the concept "assume pain is present" as a means of documenting this unconfirmed pain based solely upon the fact that procedures or pathologies exist in this patient that are normally considered painful