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A limited number of studies have addressed pain assessment among sedated patients undergoing a gastrointestinal examination. The Colorado Behavioral Numerical Pain Scale is a quick, simple tool that can provide an estimation of the patient’s comfort level while sedated. Multiple studies completed in intensive care unit and postanesthesia care unit settings provide ample evidence of the accuracy of behavioral pain scales ratings. In developing the Colorado Behavioral Numerical Pain Scale, experienced endoscopy nurses provided suggestions and modifications of descriptive words for behavioral assessment of pain selected from the relevant literature. Three nurses simultaneously rated pain using the scale for 30 procedures. Interrater reliability was high with 82% of observations in total agreement and 17% having one of the three persons disagreeing on the rating. Nurses from four hospitals and one ambulatory facility also evaluated the Colorado Behavioral Numerical Pain Scale tool. In this evaluation, 98% of the 52 respondents agreed that the words described what they observed during a gastrointestinal examination and 94% felt it was a better descriptor of pain than a patient self-report numerical scale.Assessment of pain for the sedated patient undergoing gastrointestinal procedures is often difficult due to the patient’s inability to report pain levels. The sedated patient undergoing painful procedures depends on the nurse to interpret physical signs to quantify his or her distress. The Acute Pain Management Guidelines (AHCPR, 1992) promotes the use of both physiological and behavioral responses to pain for assessment when self-report is absent. While an individual’s self-report of pain intensity and distress is the most accurate assessment measurement, the validity of a sedated patient’s elicited response about pain is questionable. It is the nurse, through observation, who attempts to assess the sedated individual’s pain levels.