Calc Function

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    Chief Complaint


    Organ System


    Patent Pending

    Nonverbal Pain Scale (NVPS) for Nonverbal Patients

    Quantifies pain in patients unable to speak (due to intubation, dementia, etc).


    One can also use the Behavioral Pain Scale (BPS) for Intubated Patients as an alternative to the NVPS.
    When to Use
    Why Use

    Patients in critical care settings for whom pain assessment is ongoing.

    • The Nonverbal Pain Scale (NVPS) allows for standardized pain assessment in intubated and other nonverbal patients.
    • Parameters include ventilator synchrony, which is helpful in intubated patients.

    Nonverbal patients express pain variably, making a standardized, accurate tool helpful in the evaluation of pain. Pain can be a cause of abnormal vital signs in the ICU setting, and using a quantitative tool can help confirm or refute this hypothesis.

    No particular expression or smile
    Occasional grimace, tearing, frowning, wrinkled forehead
    Frequent grimace, tearing, frowning, wrinkled forehead
    Lying quietly, normal position
    Seeking attention through movement or slow, cautious movement
    Restless, excessive activity and/or withdrawal reflexes
    Lying quietly, no positioning of hands over areas of the body
    Splinting areas of the body, tense
    Rigid, stiff
    Baseline vital signs unchanged
    Change in SBP>20 mmHg or HR>20 bpm
    Change in SBP>30 mmHg or HR>25 bpm
    Baseline RR/SpO₂ synchronous with ventilator
    RR >10 bpm over baseline, 5% decrease SpO₂ or mild ventilator asynchrony
    RR >20 bpm over baseline, 10% decrease SpO₂ or severe ventilator asynchrony


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    Next Steps
    Creator Insights


    Pain can and should be treated, especially in intubated patients or those who are otherwise unable to express their sensorium.


    Addition of selected points.

    Facts & Figures

    Score interpretation:

    • Scores ≤2 indicate no pain.
    • Scores 3-6 indicate moderate pain.*
    • Scores ≥6 indicate severe pain.*

    *Note: Scores ≥3 indicate possible need for analgesia.

    This assessment is normally documented every 4 hours on nursing flow sheets and completed before and after interventions.

    Sepsis, hypovolemia, and hypoxia need to be resolved prior to interventions.

    Ms. Margaret Odhner

    About the Creator

    Margaret Odhner, RN, BSN, CCRN, is an adult nurse practitioner at the University of Rochester.

    To view Ms. Margaret Odhner's publications, visit PubMed

    About the Creator
    Ms. Margaret Odhner