Directives of use of the CPOT
1. The patient must be observed at rest for one minute to obtain a baseline value of
the CPOT.
2. Then, the patient should be observed during nociceptive procedures (e.g.
turning, wound care) to detect any changes in the patient’s behaviors to pain.
3. The patient should be evaluated before and at the peak effect of an analgesic
agent to assess whether the treatment was effective or not in relieving pain.
4. For the rating of the CPOT, the patient should be attributed the highest score
observed during the observation period.
5. The patient should be attributed a score for each behavior included in the
CPOT and muscle tension should be evaluated last, especially when the
patient is at rest because the stimulation of touch alone (when performing
passive flexion and extension of the arm) may lead to behavioral reactions.
Observation of patient at rest (baseline).
The nurse looks at the patient’s face and body to note any visible reactions for an observation
period of one minute. She gives a score for all items except for muscle tension. At the end of
the one-minute period, the nurse holds the patient’s arm in both hands – one at the elbow,
and uses the other one to hold the patient’s hand. Then, she performs a passive flexion and
extension of the upper limb, and feels any resistance the patient may exhibit. If the
movements are performed easily, the patient is found to be relaxed with no resistance (score
0). If the movements can still be performed but with more strength, then it is concluded that
the patient is showing resistance to movements (score 1). Finally, if the nurse cannot
complete the movements, strong resistance is felt (score 2). This can be observed in patients
who are spastic.
Observation of patient during turning.
Even during the turning procedure, the nurse can still assess the patient’s pain. While she is
turning the patient on one side, she looks at the patient’s face to note any reactions such as
frowning or grimacing. These reactions may be brief or can last longer. The nurse also looks
out for body movements. For instance, she looks for protective movements like the patient
trying to reach or touching the pain site (e.g. surgical incision, injury site). In the mechanically
ventilated patient, she pays attention to alarms and if they stop spontaneously or require that
she intervenes (e.g. reassurance, administering medication). According to muscle tension, the
nurse can feel if the patient is resisting to the movement or not. A score 2 is given when the
patient is resisting against the movement and attempts to get on his/her back.