ADULT NONVERBAL PAIN

SCALE
REYES, SARMON,
SICAT, SOLAS

ADULT NON-VERBAL PAIN SCALE

Description:

Odhner developed a pain scale

for critically ill adults who
are unable to verbalize. The
scale was based on the FLACC
(Face, Legs, Activity, Cry,
Consolability) scale used in
children.

ADULT NON-VERBAL PAIN SCALE

Objective:
-severity, prognosis, stage
-To evaluate the effect of
implementing a new pain assessment
tool in a trauma/neurosurgery
intensive care unit.
Specialty:Critical Care Medicine,
Pain Medicine

IMPAIRMENT
The

accurate assessment of pain in

nonverbal patients is difficult,
with nurses often relying on a
variety of methods to determine
medication impact.
Much of the evidence to date
suggests that commonly used
indicators of pain may not
effectively measure the true extent
of distress in patients unable to
verbalize their level of discomfort

IMPAIRMENT
Pain can be difficult to assess
in cognitively impaired
individuals because their selfreports of pain can be
inaccurate or difficult to
obtain. Thus, behavioral
observationbased assessment is
optimal in these patients.

IMPAIRMENT
Common pain behaviors are as follows:
Facial expressions: Frowning,
grimacing, distorted expression, rapid
blinking
Body movements: Rigid, tense,
guarding, fidgeting, increased
pacing/rocking, mobility changes such
as inactivity or motor restlessness
Changes in activity patterns: Appetite
change, sleep change, sudden cessation
of common routines
Mental status change: Crying,
increased confusion, irritability,
distress

ELEMENTS OF PAIN ASSESSMENT

Functional Impairment: Does pain
interfere with ADLs, fulfilling roles?
Psychosocial Assessment: Anxious,
depressed?
Beliefs and Attitudes about pain: e.g.
Expected with aging? Punishment?
Pain Goals: Realistic? Talking about
intensity or functionality?

SIGNIFICANCE OF THE TOOL

Nonverbal

Pain Assessment Tool

The NPAT consists of 5 domains:
emotion, movement, verbal cues,
facial cues, and
positioning/guarding. Two
separate scoring systems are
provided on the instrument for
use in both verbal and nonverbal
patients.

SIGNIFICANCE OF THE SCORE

Although designed for non-communicative
critically ill patients, the NPAT has not
been validated in this population of
patients; the initial testing of the third
phase was done in verbal medical-surgical
patients. In addition, the inclusion of a
verbal cues domain in a nonverbal pain
assessment tool is confusing.

SIGNIFICANCE OF THE SCORE

CONCLUSION
Pain

experiences of older adults

are often complex and
multidimensional, and require
multidisciplinary management.
Effective pain control for all
persons must become a major
component of health care in all
treatment settings.

CONCLUSION
A systematic process by which pain is
recognized, assessed, documented, and
reassessed on a regular basis will
result in improved pain management for
all patients, especially older adults.
The process begins with each member of
the health care team becoming pain
vigilant,

REFERENCES
http://www.aacn.org/wd/ntispeakermats/
PosterPresentations/00038730/index.htm
l
http://www.criticalcarecanada.com/pres
entations/2011/assessing_and_preventin
g_pain.pdf

http://www.medal.org/the-adult-nonverb
al-pain-scale-of-odhner-et-al
http://www.aacn.org/wd/cetests/media/c
1333.pdf

http://www.ncbi.nlm.nih.gov/pubmed/205
95216