Communication is an essential tool for health professionals but we don´t always give the value and attention it deserves.

In the case of the assessment of pain, verbal communication with the patient is the key, thus the oral report or self-report of the level of pain by the patient is considered the gold standard for the evaluation.

Most of the patients admitted to the ICU spend a period of time in which their verbal communication ability is lost, either by own pathology, level of sedation and/or mechanical ventilation, creating a barrier for rating pain.

But the fact that a patient can not verbally communicate the pain suffered, does not deny what he/she is feeling, and we must assume the presence of pain in non-communicative patients just as in communicative patients, when we do similar procedures.

In recent years, tools based on the association of behaviors have been developed, such as certain facial expressions or bodily movements and the presence of pain, allowing closer to the pain experienced by patients who cannot communicate verbally, but despite its knowledge by the professionals, its use is limited.

Among the reasons that are described in the literature is the excess of technology, which often misleads us observation of the patient and the detection of such expressions of pain. The lack of time, is another reason why we do not stop to observe the patient, giving priority to other care.

I hope this reflection, make us think and raise awareness of the importance of stopping a few minutes and observe the patient to assess if they are feeling pain.

Communication is not only verbal communication.

Source: Rahu MA, Grap MJ, Cohn JF, Munro CL, Lyon DE, Sessler CN.
Facial expression as an indicator of pain in critically ill intubated adults during endotracheal suctioning. Am J Crit Care. 2013;22(5):412-22 

Candelas López López
Trauma and Emergency ICU nurse
Hospital Universitario 12 de Octubre