If someone can’t talk – how do they tell you they have pain?

The list is lengthy – the list of people who can’t tell you where the pain is, how bad it is, or even if they have it. We think of the elderly who have diseases like Alzheimer’s as one group, but there are also those who have had strokes and can no longer communicate, developmentally delayed people, young children, even people who can’t speak to you in a language that you can understand.

So, if you love or take care of someone who can’t communicate – how do you tell if he or she has pain?

You need to be observant and pick up on body and nonverbal cues; some are obvious, others may not be.

Changes in behavior or demeanor: Does the person seem more agitated or aggressive than usual? Or the opposite – is he quieter and trying to move less than usual? Is she moving repetitively, like rocking back and forth? Is he pacing when he usually doesn’t? Is she newly refusing to do things?

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    • http://www.helpmyhurt.com Marijke Durning, RN

      Do you have any hints to add? Do you find this information to be helpful?

    • http://community.wegohealth.com/profiles/blog/show?id=2028394:BlogPost:23070&page=1#comment-2028394:Comment:23454com/profiles/blog/list?user=2dd5v4e9sav3c Ellen Schnakenberg

      Awesome and very helpful post Marijke! I have another similar post in my blog that talks about a new paper that recently came out for physicians, teaching them about some of these very things. Coming from a veterinary background, it seemed so obvious to me to look for these things, it never occurred to me that someone might have to be taught to be observant for these specific clues. There are more too, but you definitely hit on the easiest and best! Now, if we could just get our docs to look at these things too instead of asking someone with aphasia to describe their pain….!

    • http://www.helpmyhurt.com Marijke Durning, RN

      Thanks Ellen. Yes, we need to get everyone on board with this- sadly it’s not something that is as obvious to us as we think it should be.

      I think I learned most of my nonverbal cuing when I worked in palliative care, watching how our patients slept or when they were sitting alone in their room. Words are definitely not necessary if you are a good observer. I know I need a lot of practice though.

    • http://community.wegohealth.com/profiles/blog/show?id=2028394:BlogPost:23070&page=1#comment-2028394:Comment:23454com/profiles/blog/list?user=2dd5v4e9sav3c Ellen Schnakenberg

      Marijke,

      I was once blessed with a physician who told me things that were bothering me without me saying a word. It took about 3 seconds for him to assess me, and his questions were very specific, which confused me. When asked how he knew what was bothering me, he told me simple things like, “I see that you’re a mouth breather, that usually means sinus issues…” yadda-yadda. That was my intro into the human side of observation guided assessment.

      I’d kill for a doc like that one again.

      What happened to them all? I go back into the old medical books from my great-great grandparents and see it mentioned all the time…

    • Pingback: August Pain-Blog Carnival | How To Cope With Pain Blog

    If someone can’t talk – how do they tell you they have pain?

    The list is lengthy – the list of people who can’t tell you where the pain is, how bad it is, or even if they have it. We think of the elderly who have diseases like Alzheimer’s as one group, but there are also those who have had strokes and can no longer communicate, developmentally delayed people, young children, even people who can’t speak to you in a language that you can understand.

    So, if you love or take care of someone who can’t communicate – how do you tell if he or she has pain?

    You need to be observant and pick up on body and nonverbal cues; some are obvious, others may not be.

    Changes in behavior or demeanor: Does the person seem more agitated or aggressive than usual? Or the opposite – is he quieter and trying to move less than usual? Is she moving repetitively, like rocking back and forth? Is he pacing when he usually doesn’t? Is she newly refusing to do things?

    Guarding: Does she appear to be protecting a certain part of the body, as if in an effort to protect it? Is he constantly touching, rubbing or massaging a part of his body?

    Appetite: Is she eating less than normal? Does his appetite seem to have waned?

    Sleep: is she waking more often during the night than she used to? Is he tossing and turning more while in bed?

    Mental status: Does she cry more or is her crying different from it used to be? Does he seem to be wandering more or did he wander but has stopped? Does she seem more irritable or defensive?

    Posture: Does she seem to be more hunched over than usual? Is he holding his body more tensely than usual? Is she limping or having trouble maintaining balance?

    It may seem like this is a long list, but it’s merely a guideline to help you understand what types of things may indicate pain or discomfort. Many times, a caregiver says after the fact, “if only I’d noticed….” Hopefully, this will help you understand what sorts of things to watch for.

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