2.3 Explain how to recognise that an individual is in pain when they are not able to verbally communicate this

This guide will help you answer 2.3 Explain how to recognise that an individual is in pain when they are not able to verbally communicate this.

Understanding the signs of pain is critical in health and social care, especially when supporting individuals who cannot verbally express their discomfort. This skill is essential to providing effective and compassionate care. There are many reasons why individuals may not communicate their pain verbally. These include cognitive impairments, neurological conditions such as dementia, physical disabilities, language barriers, or even personal preference.

Your role involves observing and interpreting pain signals accurately so that timely care can be provided. In this guide, we will explore the key ways to identify when someone may be in pain without verbal communication.

Facial Expressions

Facial expressions are one of the most common and reliable indicators of pain. Even when someone cannot speak, their facial expressions often reflect their discomfort. Specific expressions to watch for include:

• Grimacing – tightening of the facial muscles, particularly around the mouth.
• Frowning – a knitted brow or downward-turning mouth.
• Wincing – a momentary expression of distress or withdrawal.
• Clenched jaw – tension in the face and jaw muscles.

These expressions can happen spontaneously or in response to certain activities, such as moving a painful limb. Regular observations of facial expressions in different scenarios can help identify patterns linked to discomfort or suffering.

Body Language and Posture

People in pain often change their posture or movements as a way of coping. Some non-verbal signs of pain through body language include:

• Restlessness – shifting position frequently, tapping fingers, or fidgeting.
• Guarding – protecting a specific area of the body, such as holding a limb or avoiding touch.
• Stiffness – rigid movements or an inability to move smoothly.
• Curling into a foetal position – bending legs toward the torso, which may signal abdominal or widespread pain.
• Reduced movement – hesitation or reluctance to move parts of the body.

These physical signs may vary depending on the severity and location of the pain. Comparisons with an individual’s usual movements and posture can be helpful.

Sounds and Vocalisations

Even if someone does not use clear words, other sounds they make can provide evidence of pain. Pay attention to:

• Groaning or moaning – low-pitched intrusive sounds.
• Crying – whimpering or sobbing may indicate discomfort.
• Coughing or gasping – noises that may point to respiratory or chest-related pain.
• Sharp intake of breath – particularly noticeable during movement or when touched.
• Shouting or screaming – loud, distressed sounds in response to acute pain.

Though these sounds are not considered verbal communication, they are nonetheless expressive and should be taken seriously.

Changes in Behaviour

Behaviour changes often highlight pain in those unable to articulate their discomfort. Key changes to look for include:

• Agitation – increased irritability, aggression, or frustration.
• Withdrawal – reduced interaction or unwillingness to engage socially.
• Disturbed sleep – difficulty falling asleep, frequent waking, or a change in sleeping patterns.
• Loss of appetite – refusing food or showing a lack of interest in meals.
• Avoidance of activities – reluctance to engage in usual daily routines or hobbies.

Sometimes, these changes are subtle and may develop over time. Therefore, careful and ongoing assessment is essential.

Physiological Changes

Physical changes in the body can also signify pain. These might not always be obvious, so close observation is important. Physiological signs include:

• Increased heart rate – visible pulsations in the neck or wrist can indicate stress and discomfort.
• Rapid breathing – shallow or irregular breathing patterns are often linked to pain.
• Sweating – clammy skin can be a response to discomfort.
• Flushing or pallor – redness or extreme paleness in the skin.
• Dilated pupils – wider pupils can be a reaction to pain stimuli.
• Tensed muscles – contraction of muscle groups, visible during rest or activity.

These changes are autonomic responses, meaning they occur without conscious effort and can signal distress.

Individual-Specific Indicators

Pain is a highly individual experience. What triggers distress in one person may not be the same for another. Therefore, understanding the person’s normal behaviours, routines, and reactions is critical. Individualised indicators may include:

• Unique gestures – tapping a particular area, shaking their head, or pulling at their clothing.
• Location-specific reactions – wincing or withdrawing from touch in certain areas.
• Use of aids – reluctance to use walking aids or braces they would usually rely on.
• Non-verbal consistency – repeating the same action or movement when in discomfort.

Close communication with family or carers can help identify these personal signs of pain.

Using Pain Assessment Tools

Pain can also be assessed using scales and tools designed for non-verbal individuals. These tools help identify symptoms and provide a structured way of documenting observations. Common tools used in the sector include:

• Abbey Pain Scale – focuses on behaviours such as facial expression, body language, and alterations in eating habits.
• PAINAD (Pain Assessment in Advanced Dementia) – assesses breathing, vocalisations, and consolability.
• FLACC (Face, Legs, Activity, Cry, Consolability) Scale – measures observable behaviours in children or individuals with limited communication.

These tools support consistent evaluation and ensure that different professionals recognise the same signs.

Impact of Medical Conditions

Specific medical conditions can influence the way pain presents itself. For example:

• Dementia – individuals with advanced dementia may display increased agitation or repetitive behaviours when in pain.
• Stroke – facial weakness or inability to move limbs might mask pain.
• Autism – sensory processing differences can either heighten or dull the perception of discomfort.
• Cerebral palsy – muscle spasticity and postural limitations may cause unique expressions of pain.

Understanding the individual’s medical background can help distinguish between pain-related symptoms and baseline behaviours.

Communicating to Verify Pain

Even if verbal communication is not possible, other methods can be used to check for pain. These include:

• Using communication aids – picture boards, flashcards, or assistive technology may help uncover the source of discomfort.
• Questioning yes/no answers – asking the individual to nod or shake their head in response to direct questions (e.g., “Are you in pain?”).
• Using touch cautiously – gentle touch or movement might reveal which area is sensitive.

Combining observation with these strategies often provides a fuller picture of the issue.

Importance of Documentation

Once pain is recognised, it is important to document your findings. This record ensures that everyone involved in the individual’s care understands their current condition. Documentation should include:

• The specific signs of pain observed.
• Frequency and duration of symptoms.
• Actions taken to alleviate the discomfort.
• Any feedback from the individual or their family.

Sharing this information ensures a coordinated response and prevents unnecessary suffering.

Final Thoughts

Recognising pain in non-verbal individuals involves being observant, patient, and responsive. By interpreting facial expressions, body language, behaviours, and physical changes, you can determine when someone is in distress. Using tools and involving others ensures a consistent approach. Documenting these concerns further supports effective care, helping to improve the comfort and quality of life for the individual. Developing these observation and assessment skills will greatly enhance your ability to meet the needs of those who rely on your care.