How to recognise pain when someone cannot communicate
Why pain can go unnoticed
Pain isn’t always easy to communicate, but changes in behaviour and body language can help you to recognise it.
Pain can usually be communicated through language, yet many people are non-verbal or may have difficulty communicating their thoughts. For example, if your family member has dementia, they may become confused as to the pain they’re feeling, where it’s located, and especially how to communicate it. This is often why some people may be living in pain, and it can often go unnoticed.
However, you may still be able to judge when someone is in pain based on their non-verbal behaviours. For example, when we are happy, we show this by smiling, laughing, eye contact and open body language. We can similarly view other behaviours if the person is in pain.
Behavioural and physical signs of pain
Facial expressions and body language
Pain can often be noticed through changes in a person’s facial expressions and body language. They may frown, grimace, clench their teeth or appear tense. You may also notice them guarding a particular area, becoming restless, or changing their posture to avoid discomfort.
Sounds and changes in breathing
People experiencing pain may make sounds such as groaning, sighing, crying or calling out. Their breathing may also become faster, shallower or irregular. These changes can be particularly important to notice in someone who finds it difficult to communicate their pain verbally.
Changes in mood and behaviour
Pain can affect how someone feels and behaves. They may become unusually quiet, withdrawn, anxious, irritable or agitated. A person who is normally sociable may lose interest in activities or become less willing to interact with others.
Changes in sleep, appetite and movement
Pain can interfere with everyday routines, including sleep and eating. Someone may have difficulty falling or staying asleep, eat less than usual, or lose interest in food and drink. They may also move more slowly, avoid certain movements or activities, or need extra support when walking or changing position.
Knowing what is normal for your loved one
Understanding what is normal for your family member can make it easier to recognise when something has changed.
Everyone experiences and shows pain differently, so knowing their usual behaviour, routines and mannerisms can help you spot signs that they may be uncomfortable or unwell.
Common causes of pain that are easy to miss
Constipation and UTIs
Constipation can cause stomach pain, bloating, nausea and discomfort when using the toilet. For someone who struggles to communicate, it may instead appear as restlessness, agitation or a behaviour change. UTIs can cause burning when passing urine, needing to urinate more often, lower abdominal pain and feeling generally unwell. In elderly people, a sudden change in behaviour or confusion can often indicate that something is wrong.
Pressure sores and skin problems
Pressure sores can develop when someone spends long periods sitting or lying in the same position. They often affect areas such as the heels, hips, elbows and tailbone, and can begin with redness, swelling, tenderness or changes in the skin. Other skin problems, including irritation from friction or poorly fitting clothing, can also be painful. Look out for flinching, restlessness, changes in posture or resistance during personal care.
Dental pain and ill-fitting equipment
Toothache, sore gums, mouth ulcers and ill-fitting dentures can make eating, drinking and speaking uncomfortable. Someone experiencing dental pain may eat less, avoid certain foods or become distressed during mealtimes. Equipment that is too tight, loose or poorly positioned can also cause pain and rubbing. Regularly checking dentures, footwear, braces, cushions and other equipment can help identify problems.
Pain assessment tools that can help
Pain assessment tools can help carers and healthcare professionals recognise changes in behaviour and identify possible discomfort. Two commonly used tools are the Abbey Pain Scale and PAINAD scale, particularly when supporting people living with dementia or cognitive impairment.
The Abbey Pain Scale
The Abbey Pain Scale is designed to help assess pain in people who may be unable to communicate verbally. It looks at signs such as vocalisations, facial expressions, body language, changes in behaviour and physical or physiological changes.
The PAINAD scale
The PAINAD (Pain Assessment in Advanced Dementia) scale helps healthcare professionals assess possible pain in people with advanced dementia who may have difficulty expressing how they feel. It considers observable signs such as breathing, negative vocalisation, facial expression, body language and changes in behaviour.
What to do when you suspect pain
Simple comfort measures to try first
If you suspect someone is experiencing pain, start by helping them feel safe and comfortable. Encourage them to rest, adjust their position, and make sure they have easy access to food, drinks and anything they may need. Gentle reassurance, a calm environment and familiar company from their carer can also help. Always follow their care plan and any guidance from healthcare professionals, particularly if they have prescribed pain relief.
When to contact a GP or district nurse
Contact a GP or district nurse if the pain is new, persistent, getting worse or affecting the person’s daily life. You should also seek professional advice if comfort measures are not helping, if you notice a significant change in their behaviour, or if you are unsure what may be causing their discomfort. If the person appears seriously unwell or has severe, sudden pain, seek urgent medical help.
How Helping Hands supports comfort and pain management at home
At Helping Hands, we take pride in our ability to adapt to your needs. We can offer expert home care on a live-in, visiting or respite basis.
Visiting care
Live-in care
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Here at Helping Hands, our service is regulated by the Care Quality Commission (CQC) and the Care Inspectorate Wales (CIW).
This means we need to consistently meet high standards and are monitored by our regulators.
