Pain in the Cognitively Impaired - Heart 'n Home Hospice & Palliative Care, LLC

Pain in the Cognitively Impaired

Not all patients have the ability to express, in words, the amount of pain they are feeling due to their disease process.  Pain in the cognitively impaired can be recognized by factors, other than words, such as body language.  Below are some red flags to watch for when determining pain in a patient that may be unable to speak:

  • Change in Behavior: increased agitation, decreased activity, decreased oral intake
  • Nonverbal Complaints: expression of pain (not in words), moans, groans, grunts, cries, gasps, sighs
  • Facial Grimaces/Winces: furrowed brow, narrowed eyes, tightened lips, jaw drop, clenched teeth, distorted expressions
  • Bracing: clutching or holding onto side rails, bed, tray table, or affected area during movement
  • Restlessness: constant or intermittent shifting of position, rocking, intermittent or constant hand motions, inability to keep still
  • Rubbing: massaging affected area

It is important to use verbal reports AND behavior observations when documenting pain.  Be careful not to make assumptions based on medical diagnoses or scores on rating scales.  Too often, clinicians assume that the patient can’t report pain, so the question is never asked.  So, learn to become observant to non-verbal pain indicators.  Cognitively impaired patients communicate their level of pain more than one would think.


Adapted with permission from the Swedish Institute – PERT Program


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