1. Attempt to obtain the patient’s self-report, the single most reliable indicator of pain.

2. Consider the patient’s condition or exposure to a procedure that is thought to be painful. If appropriate, assume pain is present (APP); if approved by institution policy and procedure, document APP.

3. Observe behavioral signs (e.g., facial expressions, crying, restlessness, and changes in activity).

A surrogate who knows the patient (e.g., parent, spouse, caregiver) may be able to provide information about underlying painful pathology or behaviors that may indicate pain.

4. Evaluate physiologic indicators with the understanding that they are the least sensitive indicators of pain and may signal the existence of conditions other than pain or a lack of it (e.g., hypovolemia, blood loss).

5. Conduct an analgesic trial to confirm the presence of pain and to establish a basis for developing a treatment plan if pain is thought to be present.