Pain Behavior Tool Critique

Clinicians often seek information on the array of tools available for assessing pain in those with dementia unable to self-report their pain. Many of the existing tools have been included in integrative and systematic reviews and have varying levels of psychometric support, validation in different languages and clinical usefulness.

We are providing information that can be helpful in understanding the differences between tools and the fit of a given tool with the population of interest.  A pain behavior assessment tool can be used as part of a comprehensive assessment.  See Assessment in Cognitively Impaired for more information on assessment of pain in persons with dementia.

We provide information on selected pain behavior tools and have organized the tools into those most recommended for clinical use by English-speaking caregivers and other tools.

For each tool, we provide a summary about the tool and its reliability and validity and clinical utility that includes contact information for the tool and a reference list of studies that examine the tool.  In addition, if we were able to obtain permission we have placed a copy of the tool that can be downloaded and used for clinical purposes.

As specified below, this tool critique was last completed in 2019.

List of Nonverbal Pain Behavior Tools 2019

List of Nonverbal Pain Behavior Tools 2019

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):  Summary | Tool
  • CNPI (Checklist of Nonverbal Pain Indicators):  Summary | Tool
  • Doloplus 2 (Doloplus-2 Scale, Behavioural Pain Assessment in the Elderly): Summary | Website (Contract information for Tool Developer)
  • MOBID-2 (Mobilization Observation Behavior Intensity Dementia Pain Scale - 2):  Summary | Tool
  • PACSLAC (The Pain Assessment Scale for Seniors with Severe Dementia):  Summary | Tool
  • PACSLAC-II (The Pain Assessment Scale for Seniors with Severe Dementia - II ):  Summary | Tool
  • PAINAD (The Pain Assessment in Advanced Dementia Scale):  Summary | Tool

Other Tools

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

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):  Summary | Tool
  • PIMD (Pain Intensity Measure for Persons with Dementia):  Summary | Tool

Webpage Last Revised 06.26.2023