A number of nonverbal pain behavior tools have been developed to identify pain in persons with dementia.  Because tools vary on population focus, type of pain problem, setting of care, and characteristics evaluated, it is difficult to choose one tool that fits all cognitively impaired older adults.

The following group of tools includes those that have broad exposure beyond their country of origin and testing with a variety of cultures and settings and have the most extensive psychometric testing overall.  They also have clinical utility based on time to train to use and to administer in the clinical setting.

  • ABBEY (The Abbey Pain Scale):  PDF iconSummary
  • CNPI (Checklist of Nonverbal Pain Indicators):  PDF iconSummary | PDF iconTool
  • Doloplus 2 (Doloplus-2 Scale, Behavioural Pain Assessment in the Elderly):PDF iconSummary  
  • MOBID-2 (Mobilization Observation Behavior Intensity Dementia Pain Scale - 2):  PDF iconSummary | PDF iconTool
  • PACSLAC (The Pain Assessment Scale for Seniors with Severe Dementia):  PDF iconSummaryPDF iconTool
  • PACSLAC-II (The Pain Assessment Scale for Seniors with Severe Dementia - II ):  PDF iconSummary | PDF iconTool
  • PAINAD (The Pain Assessment in Advanced Dementia Scale):  PDF iconSummary | PDF iconTool

The second set of tools are others that have at least moderate reliability and validity, although variable across tools.  Several have recommendations for refinement and further testing.

  • Algoplus (Algoplus Scale):  PDF iconSummary  
  • CPAT (Certified Nurse Assistant Pain Assessment Tool):  PDF iconSummary | PDF iconTool
  • DoloshortPDF iconSummary | PDF iconTool
  • DS-DAT (Discomfort Scale-Dementia of the Alzheimer's Type):  PDF iconSummary | PDF iconTool
  • EPCA-2 (Elderly Pain Caring Assessment):  PDF icon Summary |PDF icon Tool
  • MPS (Mahoney Pain Scale):  PDF iconSummary 
  • NOPPAIN (The Non-Communicating Patient's Pain Assessment Instrument):  PDF iconSummary | PDF iconTool
  • PACI (Pain Assessment in the Cognitively Impaired):  PDF iconSummary | PDF iconTool
  • PACSLAC-D (The Pain Assessment Scale for Seniors with Severe Dementia - Dutch version):  PDF iconSummary
  • PADE (Pain Assessment for the Dementing Elderly):  PDF iconSummary
  • PAINE (Pain Assessment in Noncommunicative Elderly Persons):  PDF iconSummary
  • REPOS (Rotterdam Elderly Pain Observation Scale):  PDF iconSummary 

Two tools focus on synthesizing from existing behavior indicators in other tools and literature to identify a subset that may be most specific in identifying pain and/or determining its severity.  These include the following

  • PAIC (Pain Assessment in Impaired Cognition meta-tool):  PDF iconSummary | PDF iconTool
  • PIMD (Pain Intensity Measure for Persons with Dementia):  PDF iconSummary | PDF iconTool