The Wince Is the Report: How to Read Pain in a Wife Who Cannot Say It

When she cannot say it hurts, pain shows up somewhere else first. It shows in her face when you lift her, in a hand she stops using, in a leg she will not put weight on, or in a night that goes badly for no reason you can see. You are the one in the room who knows what her normal looks like, so the job is to write it down before you have to guess.

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What to watch for

Look for changes from her own baseline, not from some picture of what pain should look like. Common signs in a wife after a stroke or with memory loss include a wince or jaw set during transfers or dressing, guarding one shoulder or hip, pulling a limb back when you touch it, rubbing or pulling at one spot, moaning when she is moved and settling when she is still, restlessness that starts in one position, eating less or pushing food away, and sleep that breaks more often than usual.

Pain can also look like a new refusal. If she used to stand for you and now says no, ask what hurts before you push.

What to write on the day sheet

Add one line each time you see a sign. Put down the time, what she was doing, what you saw, what you tried, and whether it helped. Keep it to a few words, for example: '10:40, moving to chair, face tight, right shoulder held still, stopped, sat her back, eased after ten minutes.' Over a week that log tells a doctor more than memory will.

Keep the log in the same place every day so any helper can find it. If someone else sits with her, they read the last three lines before they start and add their own.

What to do with it

Take the log to her next appointment, or call her doctor's office or the home health nurse if one is assigned. Ask three things: which signs should be reported the same day, which can wait for the next visit, and what pain looks like for her specifically. Do not change what she takes on your own, and do not add anything from the medicine cabinet without asking first. Ask the pharmacist the same questions when you pick up a prescription.

Also ask about the moves that set it off. A transfer that hurts every time may need a different method, a second person, or a change in how the chair or bed is set up. Bring that question to her therapist, not only to the doctor.

When to stop guessing

Call for emergency help right away if her pain comes on suddenly, if one side of her looks different from the other, if she becomes hard to wake or suddenly more confused, or if you cannot tell what is wrong. Those are not times to wait for the next log entry.

You do not have to read her pain perfectly. You have to notice when it changes and write it down, so the people who can treat it have something to work with. The Start Here: A Reading Order page lists the order to read the rest of this desk.