Nonverbal Signs of Pain

The two general methods of communication are verbal and nonverbal. Estimates about general day-to-day communication interactions reveal that 50 percent to 80 percent of messages sent and received are through nonverbal methods. The same can be true with communicating the signals of pain. Small children, elderly adults and people with communication disorders are just some of those who may benefit from the observation of nonverbal signs of pain.

  1. Infants

    • A pain scale utilized by Texas Tech University Health Sciences Center provides the observer with information about nonverbal indicators of varying degrees of pain in an infant. An infant that is uncomfortable may be crying, whimpering, restless but able to sleep and able to comfort himself. Mild pain in an infant may manifest these signs, but will be difficult to distract from crying. An infant with moderate pain may be sobbing or crying loudly, may sleep only periodically and be irritable. Severe pain in an infant may include these signs along with screaming, thrashing or shaking, very still and unable to sleep.


    • Use of a similar tool for an elderly person with dementia aids the observer in determining the presence or absence of pain by noting such criteria as whether breathing is labored or non-labored, moaning or groaning, vocalizations -- even if unintelligible -- that have a negative quality, facial expressions of sadness, fear, or grimacing, fidgety behavior, pacing, striking out, pulling knees to chest, and the ability to be consoled or distracted.


    • There may be many occasions when nonverbal signs of pain will be useful to understand, including any individuals with decreased cognitive or mental function, an individual who is trying not to complain aloud, or individuals with various communication barriers. Individuals are sometimes alarmed at what condition their pain may signal. By not talking about the pain, the individual can be in a form of denial and avoidance.

    Additional Nonverbal Cues

    • An individual may walk differently or guard a part of their body, she may become depressed if pain is ongoing, or there may be signs that over-the-counter or prescription pain medications are being taken. There may be a loss of appetite, increase in fatigue, irritability or change in sleeping patterns. Your familiarity with the normal day-to-day actions and emotions of an individual help you to be alert to changes that may signal the presence of pain.

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