Which pain assessment scale is most appropriate for a nonverbal adult resident?

• A. The FLACC scale (Face, Legs, Activity, Cry, Consolability) or a similar observational scale.
• B. Numeric Rating Scale (0-10).
• C. Wong-Baker Faces scale for children.
• D. Visual Analog Scale using meters.

Answer: (C)

Pain in a nonverbal adult is best assessed with a tool that relies on observable behaviors rather than asking the person to tell you how they feel. The FLACC scale fits this need by rating five areas—Face, Legs, Activity, Cry, and Consolability—each scored 0, 1, or 2, for a total between 0 and 10. This behavior-based approach lets caregivers infer pain intensity from what they can see and hear, which is essential when self-report isn’t possible due to communication or cognitive limits.

The Wong-Baker Faces scale is designed for children and uses child-oriented facial expressions to gauge pain, which doesn’t translate well to adults and can lead to misinterpretation. Numeric Rating Scale and Visual Analog Scale require the resident to verbalize or mark pain on a line, which nonverbal adults may be unable to do reliably. So, using an observational tool like FLACC provides a more accurate, actionable assessment for an adult resident who cannot self-report.