Understanding the Signs: What are four common indicators of pain a person may display?

October 1, 2025 •

4 min read

According to the CDC, over 20% of U.S. adults live with chronic pain, a condition that can be challenging to communicate. Knowing what are four common indicators of pain a person may display can be crucial for caregivers, family members, and medical professionals, ensuring proper and timely intervention.

Quick Summary

This article outlines four key categories for identifying pain, including facial expressions like grimacing, changes in body movements such as guarding, audible distress through vocalizations like moaning, and shifts in typical behavior and mood.

Key Points

Facial Expressions: Consistent facial cues such as grimacing, wincing, and brow lowering are reliable indicators of pain, even in non-verbal individuals.
Body Movements: Guarding a painful area, restlessness, altered posture, and changes in mobility are common physical manifestations of pain.
Vocalizations: Aside from verbal complaints, non-verbal sounds like moaning, groaning, or crying can signal distress.
Behavioral Changes: Shifts in mood, such as irritability or withdrawal, alongside altered sleep and appetite patterns, can indicate pain, especially chronic pain.
Non-Verbal Assessment: For non-communicative patients, observing these behavioral and physical indicators is essential for proper pain assessment.
Acute vs. Chronic: Pain indicators can differ between acute and chronic conditions, with chronic pain often presenting with more subtle signs like fatigue and social withdrawal.

Pain is a complex, subjective experience, but it often manifests through observable signs. Learning to recognize these indicators is particularly important when a person is unable to communicate verbally due to age, cognitive impairment, or a medical condition. By looking beyond direct complaints, caregivers can better understand and address a person's level of distress.

Facial Expressions

The face is a powerful communicator, and specific facial movements are strongly associated with pain. Numerous studies, including those using the Facial Action Coding System (FACS), have identified consistent facial actions that signal discomfort across different age groups and cultures. Observing these subtle or overt changes can provide significant clues about a person's pain level.

Common Facial Pain Cues:

Grimacing or wincing: A tightening or contortion of the face in response to a painful sensation.
Brow lowering: The eyebrows are pulled down and together, often accompanied by a frown.
Orbital tightening: A squeezing or tightening of the muscles around the eyes.
Clenched teeth or jaw: A tight, rigid mouth and jaw can indicate physical strain or discomfort.
Rapid blinking: An increase in blinking rate can be a reflexive response to pain or distress.

Body Movements and Posture

Changes in the way a person moves or holds their body can be telling signs of pain. These physical indicators often reflect an attempt to protect or minimize movement in a painful area, a behavior known as guarding. These movements can be either conscious or reflexive.

Physical Indicators of Pain:

Guarding or protecting: The person might hold, massage, or shield a particular part of their body.
Restlessness: Constant shifting, fidgeting, or an inability to get comfortable.
Reduced mobility: A reluctance to move or a stiff, rigid posture, especially during transitions like standing or sitting.
Altered gait: Limping or changes in the way a person walks to avoid putting pressure on a painful limb.
Abnormal posturing: Curled up in a fetal position, hunched over, or tense muscles are often signs of acute discomfort.

Vocalizations

While verbal complaints like “ouch” are the most direct vocal indicator, people in pain may also make non-verbal sounds. These vocalizations can vary in intensity and are often involuntary responses to painful stimuli. In some cases, a decrease in vocalization or becoming quieter than usual can also signal withdrawal due to pain.

Examples of Pain-Related Vocalizations:

Moaning or groaning: Low, continuous sounds of distress.
Crying or whimpering: Sobbing or making soft, sorrowful sounds.
Sighing or gasping: Sharp intakes of breath or deep sighs can indicate pain or anxiety.
Repetitive calling out: Shouting or repeating words in a troubled or negative tone.
Noisy breathing: Labored, short, or rapid breathing patterns.

Behavioral and Mood Changes

Pain can significantly impact a person's mental state and overall behavior. These changes can be especially noticeable in individuals with cognitive impairments or those with chronic pain, who might display less obvious physical signs. Long-term pain is strongly linked with mental health changes, including anxiety and depression.

Behavioral Shifts Indicating Pain:

Agitation and irritability: Uncharacteristic anger, aggression, or a short temper, particularly when being moved or touched.
Social withdrawal: Pulling away from social interactions and activities they once enjoyed.
Confusion or restlessness: Increased disorientation, wandering, or fidgeting.
Changes in appetite and sleep: Refusing to eat, experiencing insomnia, or sleeping more than usual.
Resisting care: Pushing away caregivers or becoming combative during personal care activities.

The Difference Between Acute and Chronic Pain Indicators

It's important to differentiate between the signs of acute and chronic pain. Acute pain is often associated with a recent injury and presents with more intense, immediate indicators like loud moaning and specific guarding. Chronic pain, lasting more than three months, may cause more subtle and systemic changes, including fatigue, depression, and long-term changes in sleep patterns. Caregivers should be attuned to these differences to provide appropriate care.

Practical Observation and Assessment Tools

For individuals who cannot self-report their pain, systematic observation and assessment tools are invaluable. Healthcare professionals often use scales designed to measure pain based on these observable behaviors. For instance, the Face, Legs, Activity, Cry, Consolability (FLACC) scale is frequently used for non-verbal children and cognitively impaired adults. Another example is the Pain Assessment in Advanced Dementia (PAINAD) scale, which focuses on breathing, vocalization, facial expression, body language, and consolability. Using such tools helps standardize the assessment process and ensures more accurate evaluation. For further reading, the National Institutes of Health (NIH) offers extensive resources on assessing pain, including research on the consistency of facial expressions related to pain.

Conclusion

Identifying pain, especially when a person cannot verbalize it, requires a multi-faceted approach. Observing facial expressions, body language, vocalizations, and behavioral changes provides a comprehensive picture of a person's distress. By understanding what are four common indicators of pain a person may display, caregivers and medical staff can move beyond simple observation to proactive and empathetic care. Utilizing standardized assessment tools, acknowledging the differences between acute and chronic pain, and staying vigilant for subtle shifts in behavior are all critical steps in ensuring effective pain management and improving the patient's quality of life.


Indicator Type	Acute Pain	Chronic Pain
Facial Expressions	Often intense grimacing, wincing, and jaw clenching immediately following injury.	May be more subtle, with intermittent frowns, furrowed brows, or a pained expression becoming the default.
Body Movements	Guarding specific body parts, rapid fidgeting, or sudden withdrawal from touch.	Reduced overall mobility, stiffness, altered gait, or constant shifting to find a comfortable position.
Vocalizations	Crying, loud moaning, or sharp verbal protests like "ouch" during movement.	Frequent sighing, quiet whimpers, or a general reduction in vocal communication.
Behavioral Changes	Fear, anxiety, or visible panic.	Depression, social withdrawal, severe fatigue, or persistent changes in sleep and appetite.

Frequently Asked Questions

Non-verbal pain cues are physical or behavioral signs of discomfort that do not involve speech. These include facial expressions (like grimacing), body movements (such as guarding), and changes in behavior (like agitation or withdrawal).

Caregivers can assess pain in non-verbal patients by carefully observing changes in facial expression, body language, and behavior. Tools like the PAINAD scale provide a standardized method to evaluate pain based on these observable indicators.

Chronic pain, which lasts for an extended period, often leads to systemic changes like fatigue, depression, and sleep disturbances, which may be less obvious than the immediate, intense reactions seen with acute pain.

Yes, a person's mood can indicate pain. Increased irritability, agitation, anxiety, or withdrawal from social activities are all common mood-related indicators, particularly in those with chronic pain.

Guarding is an involuntary action where a person stiffens or protects a specific body part to avoid movement that might cause pain. It can also involve massaging or holding the affected area.

No, a quiet demeanor does not necessarily mean an absence of pain. In some cases, particularly with chronic conditions or cognitive impairments, pain can cause withdrawal and a decrease in usual vocalizations or activity.

The FLACC (Face, Legs, Activity, Cry, Consolability) scale is a behavioral pain assessment tool used primarily for non-verbal or preverbal patients, including young children and those with cognitive impairment, to measure pain through observation.