Measure and add the orange juice, cream of coconut, pineapple juice and rum to a cocktail shaker.
Fill the shaker with ice.
Seal the shaker and give it 15-20 hard shakes.
Fill the serving glass with fresh ice and strain the drink into the glass.
Garnish
Sprinkle the nutmeg over the top of the cocktail (or grate it if you're using whole nutmeg).
Add the rest of your garnish(es) and serve.
Notes
Pusser's Rum has trademarked the cocktail name Painkiller. At home, you can use your own favorite dark rum in this recipe. But, in the US and UK, it legally needs to be Pusser's in a bar setting where the drink is being sold.