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Many patients in the postanesthesia care unit are unable to provide a report of their pain because they are sedated from anesthesia and/or other drugs given during surgery. Some may be cognitively impaired or critically ill (e.g., intubated, unresponsive), and some may be too young (e.g., infants, small children) to report their pain using customary self-report pain assessment tools. These patients are collectively referred to as those who are “unable to self-report” (Herr, Coyne, McCaffery, Manworren, & Merkel., 2011). When patients are unable to report pain using traditional methods, an alternative approach based on the Hierarchy of Importance of Pain Measures (McCaffery & Pasero, 1999) is recommended (Herr et al., 2011; McCaffery, Herr, & Pasero, 2011; Pasero, 2009a). The key components of the hierarchy are to (1) attempt to obtain self-report; (2) consider underlying pathology or conditions and procedures that might be painful (e.g., surgery); (3) observe behaviors; (4) evaluate physiologic indicators; and (5) conduct an analgesic trial (see Table 5-1).