Pain Assessment in the Nonverbal Patient: Position Statement With Clinical Practice Recommendations

Keela Herr, PhD, RN, FAAN; Patrick J. Coyne, MSN, RN, CS, FAAN; Tonya Key, RN, C; Renee Manworren, MS, RN, C, CNS; Margo McCaffery, MS, RN, FAAN; Sandra Merkel, MS, RNC; Jane Pelosi-Kelly, MSN, RN, C, CS, ANP; Lori Wild, PhD, RN


Pain Manag Nurs. 2006;7(2):44-52. 

In This Article


The article presents the position statement and clinical practice recommendations for pain assessment in the nonverbal patient developed by an appointed Task Force and approved by the ASPMN Board of Directors.

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.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.