Pain is a subjective sensation that can affect a person's physical, emotional, and spiritual well-being. While pain can be measured objectively by using such as temperature, pulse, blood pressure, and respiration count, these indicators may not reflect the true intensity of pain that a person is experiencing. This is especially true for non-verbal patients, who cannot communicate their pain verbally. Non-verbal patients may include those with advanced dementia, terminal illness, or other conditions that impair their speech. In this article, I will discuss the importance of assessing pain in non-verbal patients, the tools and methods that can be used to do so, and the benefits of providing adequate pain relief for these patients.

Assessing Pain in Nonverbal Patients

Assessing pain in non-verbal patients is a challenging but essential task for nurses and other health care providers. Pain can have negative effects on a person's quality of life, such as reducing their functionality, increasing their suffering, and prolonging their dying process. Therefore, it is important to identify and treat pain in non-verbal patients as effectively as possible.

One way to assess pain in non-verbal patients is to use standardized pain scales that are designed for this purpose. There are several pain scales available, such as the Bolton Pain Assessment Tool, the FLACC Pain Scale, the NVPS Pain Scale, and the PAINAD Pain Scale. These scales use observable behaviors and physiological signs to estimate the level of pain that a non-verbal patient is experiencing. For example, the PAINAD Pain Scale uses five criteria: breathing, vocalization, facial expression, body language, and consolability. Each criterion is rated from 0 to 2, and the total score ranges from 0 to 10, with higher scores indicating more pain.

Nurses and other health care providers should learn at least one of these pain scales and use it consistently to assess pain in non-verbal patients. By doing so, they can achieve two main goals: 1) to determine the patient's level of pain and work with the providers on a treatment plan, and 2) to educate the patient's family and caregivers on how to recognize and report pain in the patient and how to administer the appropriate medications according to the treatment plan.


To illustrate the importance of assessing pain in non-verbal patients, I will share a case study from my experience as a . I cared for a breast cancer patient in her 60s who was being cared for by a parent in their 80s. One family member suspected that the patient was in pain because she was groaning, but the primary caretaker disagreed. When I arrived, I observed that the patient was groaning loudly and continuously, had labored breathing with a respiration count of 30, had a heart rate of 124, and was hypotensive at 84/40. Using the PAINAD Pain Scale, I rated her pain as 9/10, which was confirmed by the software system that we use. I explained to the family how I assessed the patient's pain and why it was important to treat it. I obtained their permission to give the patient pain medication to make her comfortable. After the medication was given, the patient's groaning and breathing eased, her heart rate and blood pressure stabilized, and she appeared more relaxed. I also reinforced the need to stay on top of the patient's and the consequences of untreated pain.


Pain is a subjective sensation that can have a significant impact on a person's quality of life. Non-verbal patients, who cannot express their pain verbally, are at risk of having their pain underrecognized and undertreated. Therefore, it is vital to assess pain in non-verbal patients using standardized pain scales and to provide adequate pain relief for them. By doing so, nurses and other health care providers can improve the physical, emotional, and spiritual well-being of non-verbal patients and their families.


Pain Assessment in Hospitalized Older Adults With Dementia and Delirium

Pain Assessment in Dementia – International Association for the Study of Pain (IASP)

Pain Assessment in People with Dementia: AJN The American Journal of Nursing

PAINAD Scale Offers Alternative to Assessing Pain in the Dementia Patient – JEMS: EMS, Emergency Medical Services – Training, Paramedic, EMT News

Pain Assessment in Advanced Dementia Scale (PAINAD) – MDCalc

Uncontrolled Pain and Risk for Depression and Behavioral Symptoms in Residents With Dementia

Chronic Pain & Symptom Tracker: A 90-Day Guided Journal: Detailed Daily Pain Assessment Diary, Mood Tracker & Medication Log for Chronic Illness Management

Pain And Symptom Tracker: Daily Pain Tracking Journal Detailed Pain Assessment Diary, Medication, Supplements Food & Activities Log for Chronic Illness Management

Pain Assessment and Pharmacologic Management

Adult Nonverbal Pain Scale (NVPS) Tool for pain assessment

Assessing pain in patients with cognitive impairment in acute care

FLACC Pain Scale

Pain Assessment in Advanced Dementia Scale (PAINAD)

Pain Assessment in Non-Communicative Adult Palliative Care Patients

Pain Assessment in People with Dementia

Tools for Assessment of Pain in Nonverbal Older Adults with Dementia: A State-of-the-Science Review

Understanding the physiological effects of unrelieved pain

Untreated Pain, Narcotics Regulation, and Global Health Ideologies

Eldercare Locator: a nationwide service that connects older Americans and their caregivers with trustworthy local support resources

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