When patients are not able to explain their pain, critical care nurses reach for one or more alternative means to assist in making these appraisals. Some recent announcements from the field of medical genetics now suggest that the pain assessment strategy for critically ill patients may need to make room for genetic variants. Although these findings are preliminary and beg for concurrence, their rapid transmission through the informal scientific community and popular press affords an opportunity to consider how they might be incorporated to better inform our current approaches to pain appraisal in the critically ill. Our sequential approach to pain assessment for critically ill patients might then resemble the basic hierarchical strategy suggested by Puntillo et al3 with a few additional aspects added for your consideration (Table 1).
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