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Nonverbal Pain Indicators (CNPI) Cheat Sheet by

Pain Eval; Patient cannot be Interviewed
assessment     emr     pain     non-interviewable


Evaluation form to determine if a patien­t/r­esident is experi­encing pain where they are not able to effect­ively commun­icate with the caregiver. We observe the signs that are usually present when a person is experi­encing pain. Patients with dementia or severe medical conditions are often not able to commun­icate intell­igently with caregivers or others.

Checklist of Nonverbal Pain Indicators (CNPI)

With Movement
At Rest
Body Positioning
Facial Grimac­es/­Winces
Furrowed brow, narrowed eyes, clenched teeth, tightened lips, jaw drop, distorted expres­sions
Constant or interm­ittent shifting of position, rocking, interm­ittent or constant hand motions, inability to keep still
Massaging affected area
Vocal compla­ints: Non-verbal
Sighs, gasps, moans, groans, cries
Vocal compla­ints; Verbal
Words expressing discomfort or pain [e.g., ouch," "that hurts"]; cursing during movement; exclam­ations of protest [e.g., "­sto­p," "­that's enough­"
Score a 0 if the behavior was not observed. Score a 1 if the behavior occurred even briefly during activity or at rest. The total number of indicators is summed for the behaviors observed at rest, with movement, and overall. There are no clear cutoff scores to indicate severity of pain; instead, the presence of any of the behaviors may be indicative of pain, warranting further invest­iga­tion, treatment, and monitoring by the practi­tioner.

Suspected Cause

Describe: ______­___­___­___­___­___­___­___­___­___­___­___­___­___­_______

Pain Management

Medications (Type, Dosage & Frequency)
Others indicate all modali­ties:


  Partial   Complete   None

Care Planning

1. Continue current pain Med(s)
 Yes No
2. Refer to Physician for:
 Medication Evaluation
 Rehabilitation Evaluation
 Exacabarating factors
 Alleviating factors
3. OOB Schedule Adjusted (Out of Bed)
 Yes No
4. Other: ______­___­___­___­___­___­___­___­___­___­___­___­___­___­______

Tips for docume­ntation

Intensity (pain scale scores or other findings)
Intens­itity, Locati­on(s)
Duration / Frequency
Interm­ittent vs Continuous / Pattern
Diurnal variation (effect of the time of day)
Precip­itating / Allevi­ating factors
Associated symptoms
Effect on functi­on/­daily activities
Goals for pain management
Pharma­col­ogical (drugs)
Patient’s response
Assessment findings post interv­ention
Any need for changes in pain management plan

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