Score each of five domains from 0 to 2 and sum the domain scores.

Domain	0 points	1 point	2 points
Face	No particular expression or smile.	Occasional grimace, tearing, frowning or wrinkled forehead.	Frequent grimace, tearing, frowning or wrinkled forehead.
Activity	Lying quietly in a normal position.	Seeking attention through movement or slow, cautious movement.	Restless, excessive activity or withdrawal reflexes.
Guarding	Lying quietly without hand positioning over a painful area.	Splinting a body area or tense.	Rigid or stiff.
Physiology	Baseline vital signs unchanged.	SBP increase >20 mmHg or HR increase >20/min from baseline.	SBP increase >30 mmHg or HR increase >25/min from baseline.
Respiratory	Baseline RR/SpO₂ and synchronous with ventilator if applicable.	RR >10/min above baseline, about 5% fall in SpO₂, or mild ventilator asynchrony.	RR >20/min above baseline, about 10% fall in SpO₂, or marked ventilator asynchrony.

Total NVPS score ranges from 0 to 10. Higher scores indicate more observed pain behaviour or physiologic distress.

Nonverbal Pain Scale (NVPS) for Nonverbal Patients