I'm sure all of us have been "fooled" at one time or another. Don't even ask me what the most pain med I have given a pt is. We use the sedation scale along with aldrete and pain level. If a patient states pain level is an 8 but sedation is a 4 and aldrete is an 8 then they are ready for discharge from PACU. One of our MD's has the pt cough (abd. or chest surg). If the pt can't cough or is splinting then they are a 7-10 if the pt coughs but winces 4-7 and if th pt coughs without problem 0-4. He uses this to "verify" what the patients states pain level is.