Non-verbal Signs of Pain

Non-verbal Signs of Pain
June 21, 2019 / Reid M. Jacobs, APHSW-C, MSW

It can be difficult to know when someone is in pain, especially if they can’t say that they’re in pain. This happens a lot when someone has severe cognitive impairment or advanced disease that hinders communication. This can be caused by progressive diseases like dementia and Parkinson’s disease, but other conditions can interfere with communication as well. People with reduced liver function due to cirrhosis, cancer, and organ failure, often become confused as the toxins that the liver normally filters out of the blood begin to collect in the body. Certain medications might cause drowsiness or confusion, as well. All of these can make it difficult for the patient to tell their caregivers if they are in pain. And this causes significant concern for everyone involved in care.

So, how do we know if a person is hurting if they can’t tell us? We look for non-verbal signs of pain. These are common facial expressions and body movements associated with pain. Although, not everyone will express all of these signs. Also, these signs don’t always mean the person is in pain, some could indicate discomfort, anxiety, agitation, or other causes. However, if caregivers think someone might be experiencing pain, these are good clues to consider.

  1. Facial expressions: Grimacing, furrowed brow, holding eyes tightly shut, pursed lips
  2. Clenched jaw, grinding teeth
  3. Grasping or clutching blankets or seat cushions
  4. Rigid body
  5. Unusual breathing patterns
  6. Moaning or calling out
  7. Not responding to voice, becoming withdrawn and less social
  8. Flinching when touched
  9. Guarding an area of pain, such as clutching it or resisting when someone tries to touch the area
  10. Kicking, restless legs, frequent repositioning, rocking
  11. Agitation, irritability, low tolerance for engaging with others

It is important to be aware of these signs of pain so they can be addressed quickly. Be sure to communicate pain and any of these non-verbal signs with your physician, palliative care or hospice team. They can help you determine if the signs are likely from pain or another cause. They can also get an understanding of where the person is hurting and, potentially, the severity of pain. You can also monitor for these non-verbal signs after pain medications are given to determine their effectiveness. Remember that you aren’t in this alone.

You might also be interested in last week’s blog post, “Pain vs. Suffering” Click here to read it.