Use of pain assessment scales in non-communicative patients

Introduction: adequate pain management in non-communicative patients represents a critical challenge in healthcare. Globally, approximately 50 % of non-communicative critically ill patients experience pain during their stay in intensive care units. However, the use of validated scales such as the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT) remains limited. In Ecuador, 87 % of medical staff do not use scales to assess pain, resulting in 66 % of patients not receiving an adequate assessment and 92 % experiencing ineffective pain management.Objective: to analyze the clinical utility and application of validated scales for the assessment of pain in non-communicative patients in hospital settings.Method: a systematic review was conducted with a qualitative-descriptive approach, using the PRISMA methodology. Twenty-seven articles published between 2020 and 2025, in English and Spanish, located in scientific databases such as PubMed, Scopus, and Scielo, were included.Results: the Behavioral Pain Scale (BPS), the Pain Indicator Behavior Scale (ESCID), PAINAD, CPOT, and NCS-R were the most frequently used. These tools were found to have good validity and reliability for detecting pain in non-communicative critically ill patients and were effective in procedures such as tracheal aspiration and mobilization. New technologies have also shown advances in the automation of pain diagnosis, although with limitations in standardization.Conclusions: adequate pain assessment in non-communicative patients is possible through validated behavioral scales, whose clinical application requires ongoing professional training and adaptation to the patient’s context.