Multiple studies have demonstrated that pain from cardiac surgery peaks over the first 2 days, then declines daily through postoperative day 6. 1 , 2 Over the first 2 postoperative days, patients most commonly report discomfort in the legs, shoulders, lower back and abdomen, as well as the midsternum. Chest tubes cause significant pain because they can irritate the parietal pleura, which is sensitive to pain and temperature. Approximately one-half of patients have pain in more than one area. After the first postoperative week there is more reported sternal and osteoarticular pain, as the pain from tubes and the incision recedes. 2 The activity that elicits the most pain for the postcardiac surgery patient is coughing, which is followed in pain intensity by patient movement, turning in bed, getting up, and deep breathing. Activity-related pain scores decrease after the second postoperative day; however, pain from coughing continues to be severe throughout the first week. Removal of chest tubes results in significant pain relief at rest and with activity