2.2 Give examples of how an individual’s behaviour may indicate that they are in pain or discomfort

This guide will help you answer 2.2 Give examples of how an individual’s behaviour may indicate that they are in pain or discomfort.

When someone is experiencing pain or discomfort, their behaviour often changes. These changes can be subtle or obvious, depending on the person and the intensity of the pain. Recognising behavioural signs can be essential, especially for individuals who may struggle to express their feelings verbally. Understanding these signs ensures appropriate care and support.

Physical Behaviours

Physical changes are a common way in which individuals show they are in pain. You might notice:

• Restlessness or fidgeting: The person may shift in their seat, repeatedly adjust their position, or pace around.
• Guarding: Protecting or holding a particular part of the body, such as cradling an arm or curling up to shield the abdomen.
• Avoidance of movement: The individual may remain very still, avoid sitting up, or resist certain actions like standing or bending.
• Limping or abnormal gait: Pain in the legs, knees, hips, or feet might cause someone to walk differently.
• Tenseness or stiff posture: Their body might appear rigid, or they could clench muscles to avoid worsening the pain.

These behaviours indicate an attempt to manage or minimise the symptoms.

Facial Expressions

The face can often reveal discomfort. Pay attention to signs such as:

• Frowning or wincing
• Furrowing the eyebrows as if in concentration or distress
• Grinding or clenching teeth
• Grimacing, often when trying to move or when touched
• Lip biting or purse-lipped breathing

Facial expressions give an immediate visual clue, even in individuals who may not verbalise their pain.

Vocalisations

Changes in vocal tone or sounds can indicate pain. Examples include:

• Groaning, moaning, or crying softly
• Shouting or screaming in extreme cases
• Grunting or exhaling sharply while moving
• Repeating phrases like, “Ow,” or, “It’s too much.”
• Unusual silence or refusal to speak, which may indicate fear or severe discomfort

These vocal signs can vary from person to person. Some individuals become louder, while others withdraw completely.

Emotional Changes

Pain and discomfort often lead to emotional outbursts or shifts. Signs of behavioural change in emotions include:

• Irritability: The person may appear short-tempered or easily frustrated.
• Agitation: Pacing around, wringing hands, or appearing more impatient than usual.
• Withdrawal: Avoiding conversations, isolating themselves, or becoming unresponsive.
• Fear or anxiety: They may visibly display worry, especially if they associate their pain with something serious.

These emotional responses can occur even if the person is trying to hide their pain.

Unusual Reactions to Care

How someone interacts during personal care or routine tasks can often indicate discomfort. Look for examples such as:

• Resistance to being touched or assisted: This could be reluctance during dressing, bathing, or transferring from bed to a chair.
• Flinching: A sharp movement when a specific area is approached or touched.
• Non-compliance: Refusing medication, rejecting assistance, or complaining loudly during procedures.
• Increased dependence: They may start asking for more help than they usually need, such as requesting water close by or asking carers to stay with them.

These actions might be their way of trying to signal distress.

Changes in Routine or Habits

Pain or discomfort often disrupts daily habits. These changes can include:

• Sleeping more than usual or trouble sleeping: Pain may cause restlessness during the night, or the person might appear unusually fatigued.
• Changes in appetite: They may eat less or avoid food altogether.
• Reluctance to engage in hobbies or social activities: Individuals might appear uninterested in what they usually enjoy.
• Toileting issues: Avoiding the bathroom due to fear of pain, or expressing distress during toileting.

Changes in behaviour that diverge from established routines are often clear indicators of discomfort.

Aggressive or Defensive Behaviour

Some people express pain by becoming aggressive. This can include:

• Yelling or raising their voice
• Pushing carers away
• Hitting or throwing objects
• Showing unexpected anger or irrational reactions to simple situations

This behaviour often results from frustration, fear, or the inability to cope with the pain.

Communication Challenges in Non-Verbal Individuals

For individuals unable to speak or those with conditions like dementia or autism, behavioural cues can be the only way to understand pain. Some examples include:

• Rocking back and forth or other repetitive movements
• Pointing at or repeatedly touching a part of their body
• Crying or making exaggerated facial expressions without reason
• Becoming unusually clingy or distant

In such cases, carers need to rely on their knowledge of the person’s usual behaviour to identify pain-related changes.

Indicators in children and infants:

For children who cannot talk about their pain, you might see behaviours such as:

• Crying or screaming excessively
• Pulling at their ears, rubbing their tummy, or holding other body parts
• Squirming or wiggling uncomfortably
• Becoming inconsolable
• Refusing food or pushing away a bottle

These actions reflect their limited ability to communicate.

Using Behaviour to Assess Pain

Behavioural tools can help when recognising pain, especially for non-verbal individuals. These may include:

• PAINAD Scale: Used for people with dementia, this assesses pain based on body language, facial expressions, and vocalisations.
• Abbey Pain Scale: A tool specifically for use with older adults, particularly those with cognitive impairments.
• FLACC Scale: Used for children or non-verbal adults by observing face, legs, activity, cry, and consolability.

These frameworks provide structured ways to interpret behaviour as an indicator of pain.

Observing and Responding Compassionately

Caring for someone in pain involves observing behavioural signs and responding appropriately. Speak calmly to the individual, ask open-ended questions, and offer gentle reassurance. Be patient, as pain can make individuals feel vulnerable or embarrassed. Acting with empathy can help reduce distress and make them feel supported.

Final Thoughts

Pain or discomfort is often communicated through changes in behaviour rather than words. By paying attention to physical movements, facial expressions, emotional changes, and routine habits, carers can identify signals of distress and address them. Each person expresses pain differently, so knowing their usual behaviour is key to recognising when something is wrong. Acting quickly when these behaviours are noticed can help prevent further distress and provide the care they need.