Registered Nurses' Association of Ontario

Pain Assessment on Persons Unable to Self-Report

  • Not everyone is able to talk about their pain. People who are unable to talk or self-report may include:
    • Neonates, infants and preverbal children;
    • Older adults with cognitive impairment (such as advanced dementia);
    • Persons with intellectual disability;
    • Critically ill or unconscious persons; and
    • Persons who are terminally ill.
  • Here are the steps to follow when someone cannot report their pain:
    1. Attempt to have the person self-report
    2. If a person is unable to self-report, rely on behavioural indicators or behavioural pain scales validated for the specific population they belong to and the context.
    3. Obtain proxy reporting from family or caregivers about potential behaviour that may indicate pain.
    4. Minimize emphasis on vital signs because they do not discriminate pain from other sources of distress.
Clinical Management
Assessment and Management of Pain - 3rd Edition
Point of Care Resources