Pain Assessment-Nonverbal Patient: Position Statement

Pain is a subjective experience, and no objective tests exist to measure it (APS, 2003). Whenever possible, the existence and intensity of pain are measured by the patient's self-report, abiding by the clinical definition of pain that states "Pain is whatever the experiencing person says it is, existing whenever he/she says it does" (McCaffery, 1968). Unfortunately, some patients cannot provide a self-report of pain verbally, in writing, or by other means, such as finger span (Merkel, 2002) or blinking their eyes to answer yes or no questions (Pasero & McCaffery, 2002).

This position paper will specifically address three populations of nonverbal patients: elders with advanced dementia, infants and preverbal toddlers, and intubated and/or unconscious patients. The inability of these populations to communicate pain and discomfort because of cognitive, developmental, or physiologic issues is a major barrier for them being adequately assessed for pain and achieving adequate pain management interventions.