A Review of the Non Verbal Scale of Pain in Assessing the Pain of adult Patients without Verbal Communication

Pain evaluation in patients in the intensive care unit who are not often able to communicate verbally due to changes in level of consciousness, connection to the mechanical ventilation and receiving sedative medications, is a difficult and complex task and one of the most important problems of nurses. Appropriate pain measurement in these patients requires the use of a valid and reliable Scale in which behavioral and physiological indicators are used for monitoring and assessing pain. The purpose of this study is to introduce a non-verbal pain Scale for evaluating pain in patients who are not able to communicate verbally, and to review the stages of the edition and revision of its versions and validation, validity and reliability of the Scale versions.

Materials and Methods

A Structural overview with words Non-verbal pain tool, Accreditation, Intensive Care Unit, Pain was carried out in the databases Ovid, Science Direct, Scopus, PubMed, and the Google Scholar search engine the period of time from 1990 to2015, and then, content analysis was done on appropriate and relevant articles based on the relevance of the articles with the subject of the research.


Nonverbal pain scale (NVPS) was first developed by Ohdner in 2003 based on the replacement of appropriate dimensions and relevant with adult needs in scales available for patients without verbal communication which grades the state of the face, activity, guard status, change in vital signs (physiological group 1) and other physiological symptoms (physiological group 2). Vegman revised the NVPS and reported that in the second version, the respiratory group has been replaced the with the former physiologic group two. The new respiratory group includes respiratory rate gradation based on the baseline, arterial oxygen saturation as an estimated pulse oximetry, and ventilator compliance.

Discussion and conclusion:

Non-verbal pain scale (NVPS) is of particular importance for adult patients in intensive care units because it raises special issues of this unit. Its priority was confirmed based on researchers' researches due to the behavioral and physiological indices and satisfaction of nurses because of ease of use.

Article Type:
Review Article
Journal of the School of Army Nursing, Volume:19 Issue: 1, 2019
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