The Nonverbal Pain Scale(s)

Happy Early Thanksgiving 🦃

Every now and then I would recommend using a different pain scale than a numeric pain score if patients are non verbal or having cognitive impairment.

The scale is called Pain Assessment in Advanced Dementia Scale (PAIN-AD).

It makes sense to use it if we look at some of the grading of this scale

1. Breathing

2. Negative vocalization

3. Facial expression

4. Body language

5. Consolability

All the grading are not self reported, so it relies less on the ability of an already impaired patient to tell us some numbers that we likely cannot rely on.

And that reminds me of a pain scale that I learned back in PGY1 when I did critical care- the Critical Care Pain Observation Tool (CPOT)

And if we look at how the scoring is done

1. Facial expression

2. Body movements

3. Compliance with the ventilator

4. Muscle tension

You see the similarities now?

Maybe except for the compliance with the ventilator that is quite specific to the CPOT score, almost everything is identical.

Pain is a learned experience, and how we feel about pain is so different. But the physical reaction with pain when words are not an option are instinctive to many of us.

We breathe heavier as we have more pain, and we start to grimace when pain is unbearable.

So yes, there may be various versions of pain scale for patients who just cannot tell you a pain score.

Perhaps we don’t need to complicate the matter because they are very similar.

PS: If you don’t believe that, there is another score called the FLACC. And the acronym stands for Face, Leg, Activity, Cry, Consolability.

See you next time,

SP