How Can I Know if My Loved One Is in Pain if They Can’t Speak?

One of the most difficult and frustrating things about caring for someone who can’t communicate is assessing their level of physical comfort. Although nonverbal clues are not always accurate, they may be all you have to go on in determining your loved one’s pain-control needs. According to a study published in the Journal of Palliative Medicine, signs that your loved one may be in pain include the following:

• Facial expressions, such as frowning, a wrinkled forehead, tightly closed eyes, grimacing, rapid blinking or a sad or frightened look

• Vocalizations such as sighing, moaning, groaning, calling out or calling for help
• Body posture and movements, such as rigid, tense muscles, guarding (not moving or physically protecting a particular body part), restlessness, rocking or decreased mobility
• Changes in interactions with others, such as withdrawal, aggression, resistance to care, combativeness or refusal to move 

Notably, blood pressure, heart rate and respirations were not reliable indicators that patients were in pain. 

If you believe your loved one is in pain, but they are unable to speak to you, you may be able to get them to communicate through nonverbal clues. If they are conscious or semiconscious, you can ask them simple yes-or-no questions and instruct them to blink their eyes or squeeze your hand to indicate a positive response. This approach may take some time, but it can be effective. First ask them if they are in pain (“Is something hurting you?”). Then try to pinpoint the problem by narrowing it down by body parts. (“Does your stomach hurt? Your head? Your back?” etc.) If you can discern what’s hurting, that information can be an important clue as to what you can do to help. Abdominal pain, for example, is often a sign that the person is constipated. In that case, giving them more opiates can actually make the situation worse. They may just need a laxative or an enema to relieve the discomfort they feel. 

If you can’t determine whether or why your loved one is hurting, it’s better to err on the side of caution and assume they are in pain. If they have an order for medicine for breakthrough pain, try giving them a dose and assessing their demeanor afterward. You can also try repositioning them, playing some soft music, dimming the lights and speaking to them in a soft, comforting voice. Physical pain is very often only part of the reason for a dying person’s distress. Helping your loved one to feel emotionally supported can be as effective as giving an extra dose of a painkilling drug. 

Sources 

“Assessing Pain in Nonresponsive Hospice Patients: Development and Preliminary Testing of the Multidimensional Objective Pain Assessment Tool (MOPAT)”. Journal of Palliative Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC3114254/ 

“Breakthrough pain: definition, prevalence and characteristics”. PubMed. https://pubmed.ncbi.nlm.nih.gov/1697056/