It has long been known that the gold standard for measuring a patient’s pain is his or her self-report.1  But what about patients who are nonverbal? There is always the default assessment of “assume pain present.” The question then becomes: “How does the health care team assure that pain is safely and adequately treated in these patients?” Assessment is only part of the main management equation.

In a study by Rose and colleagues2  nurses reported they were “less likely to use a pain assessment tool for patients unable to communicate than for patients able to self report” even though there are valid and reliable clinical scoring tools to identify and quantify pain in these patients. When working with neonates or pediatric patients, the assessment tools may differ from those in nonverbal adults, however, the need to assure safety and consistency in evaluation and treatment does not change.

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