Really good question: Some people don't want to express much when they're hurting, it's true. For instance, some native american cultures may seem this way. One thing you can try is a simple pictorial pain scale like the wong-baker http://www.Partnersagainstpain.Com/printouts/a7012as6.Pdf you might also observe changes in facial expression, muscle tension, agitation, pulse, bp, respiration, and even sweating.
Answered 12/9/2013
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