How can I tell if my family member is in pain if they can’t tell me?

Research from my studies show that family members have many challenges assessing a loved ones pain. It is scary giving narcotics that you have been told are addictive and dangerous, even fatal. When your patient is well enough to tell you they hurt or decide for themselves they need medicine then you feel fairly comfortable. Once their disease has advanced and they can no longer communicate, you have to decide if they need the pain medicine, and it can be very scary. We have had caregivers tell us they are afraid they killed their loved one with the final doses of medicine because they were just guessing or doing what the doctor said, even though they were unsure if they were in pain.  Below is one of many comments caregivers have made regarding trying to decide if they should give medicine.

Once the medication was started, I think that he was probably in more pain than we realized sooner. And again, because he may not have been able to tell us about the pain, and maybe he wasn’t seen by his regular nurse right at first there might have been some problem . because, when In reply to: would ask him, he would say he was not in pain, but his actions indicated, the nurse was able to determine he was in pain.

Below are some hints that can help you determine if someone is in pain and if you should give the prescribed medication. You can assess 5 different ways the pain your loved one may be experiencing.

1. Look at the Face- People in pain often show it in their face. They may have a grimace of some kind, they may have tears, eyes may be closed as they are concentrating on not hurting. There is a Faces of Pain Scale that can help in the rating of pain if someone can’t tell you.

2. Breathing- How heavily are they breathing, are they struggling? Pain can take a toll on the respiratory system as the body compensates for the discomfort. Their breathing may be more rapid than normal as the body works harder.

3. Movement is another thing to observe. Do they favor one part of their body? Are they constantly moving around in an effort to get comfortable? Do they appear restless? Are they rubbing a part of their body?

4. Sounds are another good indication, even when someone is sleeping. Are they moaning or making unpleasant sounds, especially when they are moving? This could indicate pain.

5. Can they be comforted in some way without medicine? Sometimes ice, or heat, or darkness, light, massage, or even repositioning can help. If those things bring relief then medication may not be needed.

Palliative care and hospice physicians tell us that we should always believe the patient when they tell us they are in pain. They also tell us its important to stay ahead of the pain and not let it get out of control because once it does it can be difficult to get back in control. When caregivers need to rate the pain for their loved one these five things may help you decide, so be observant and note these “symptoms” of pain.

Research published by Debra Parker Oliver, Elaine Wittenberg-Lyles, Karla Washington, Robin Kruse, David Albright, Paula Baldwin, and Amy Boxer, "Hospice caregivers' concerns with pain: "I'm not a doctor and I dont know if I helped her go faster or slower" Journal of Pain and Symptom Management 2013 46(6) p846-858.