Paper Pain Assessment

This article is taken from the whitepaper “Modern Pain Assessment in Aged Care”. Download the full whitepaper.

Despite the existence of over 30 observational, paper-based pain assessment tools, there is no one gold, universal global standard. Variability exists in content and scoring systems across the different tools, as well as evidence of each tool’s reliability, validity, and clinical utility[1].

Furthermore, several limitations of paper-based pain assessment methods have been identified as barriers to implementing consistent and standardised pain assessment protocols.

In this article, we look at the main challenges of paper-based methods and how digital pain assessment tools support accurate and rapid pain assessment at the point of care.

Limitation 1: Behavioural ratings are subjective

The subjective nature of pain makes quantification difficult, yet many clinicians rely upon observations and measures to assess and infer the pain experienced.

Many modern pain assessment frameworks do not adequately tackle this problem as they do not delineate how different forms of assessments relate to the subjective experience of pain. As a result, on any given scale, one carer may interpret cues differently to another — leading to inconsistency on pain assessment and subsequent management.

Limitation 2: Familiarity with the patient is often recommended

In many cases, pain assessment methods assume or require a level of familiarity with the patient or resident. For example, guidelines from the British Pain Society recommend that pain assessment in residents with dementia should include insights from familiar carers and family members, as pain behaviours may differ between individuals[2] and those familiar to them are most able to pick up on changes in behaviour.

However, it is important to note that in care homes, there are often multiple staff members caring for a single resident, including those who are unfamiliar with the individual. As a result, residents may receive a variety of different pain assessments throughout an average week, and these carers may not contact other parties to obtain personalised insights on pain-related behaviours.

Limitation 3: Assessing pain manually requires specialised knowledge, which is hard to access

Many pain assessment tools require nurses to have a certain level of experience and confidence to use the tool.

A study from Canada[3] found that education is often necessary in pain assessment practices, given there are well-documented knowledge gaps and most tools require specialised knowledge. Findings reveal that pain assessment knowledge increases and pain practices improve among nursing staff following in-person or video-based training programs. However, these are not typically provided in professional training programs for carers.

Additional challenges of pain assessment in aged care

  • There are capability gaps in understanding pain assessment for residents experiencing dementia and cognitive impairment.
  • Clinicians can at times struggle to differentiate dementia behaviours compared to underlying pain behaviours.
  • Pain assessment is fragmented with various scales, tools and reporting.
  • Documentation of historical pain assessments is poor. Often, carers will conduct a pain assessment on a resident, make observations, then sit down at the end of the shift to write notes for the subsequent shift — creating inefficiencies in both care planning and effective communication with clinicians.

An overview of key limitations by pain assessment tool or framework

Pain assessment

PainChek®: Overcoming limitations to enable best-practice pain assessment

PainChek® is the world’s first regulatory cleared medical device that combines AI-driven facial analysis with the Numerical Rating Scale (NRS) to overcome common limitations and enable best-practice pain assessment both for those who can and cannot reliably self-report their level of pain.

With PainChek®, carers use their camera-enabled smartphone or tablet to allow automated facial recognition and analysis to observe an individual’s face. The app then analyses the images (without storing) in real-time and automatically recognises facial muscle movements indicative of pain.

PainChek® delivers smart point-of-care pain assessment and automated data collection, which can improve clinical outcomes and support accreditation standards. It is currently being used globally in over 1,500 aged care facilities, with more than one million digital pain assessments conducted to date, and is trusted by thousands of nurses, carers and clinicians.

Yvonne Ayre, General Manager of residential aged care provider Regents Garden, talks about the accuracy of pain diagnosis through PainChek® assessments – which in turn enables a more accurate treatment plan:

“Having the evidence to support a pain diagnosis has often proved difficult when caring for people with dementia. Pain and behaviour management often go hand in hand and PainChek® has provided us with a simple but effective tool to diagnose that a person has pain and effectively manage that pain. As a result, we now have a number of documented cases of reduced use of behaviour medications (such as antipsychotics) and an improvement in the quality of life for the residents.”

To find out more about the latest pain assessment insights and the clinical validity of PainChek®, download our whitepaper “Modern Pain Assessment in Aged Care” and register for our free upcoming webinar for Australian and New Zealand aged care professionals.

[1] Lichtner et al. (2014) Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools. BMC Geriatr 14, 138. Available at [online].
[2] Schofield, P. (2018) The Assessment of Pain in Older People: UK National Guidelines. Available at: [online].
[3] Gallant et al. (2020). Provincial legislative and regulatory standards for pain assessment and management in long-term care homes: a scoping review and in-depth case analysis. Available at: [online].
[4] Brown, D. (2011). Pain Assessment with Cognitively Impaired Older People in the Acute Hospital Setting. Available at: https://www. [online].
[5] Ersek et al. (2010). Comparing the Psychometric Properties of the Checklist of Nonverbal Pain Behaviors (CNPI) and the Pain Assessment in Advanced Dementia (PAIN-AD) Instruments. Available at: [online].
[6] Neville, C & Ostini, R. (2014). A psychometric evaluation of three pain rating scales for people with moderate to severe dementia. Available at: [online].
[7]  Schofield, P & Abdulla, A. (2018). Pain assessment in the older population: what the literature says. Available at: [online].

Don't miss out!
Sign up to receive the latest news and updates from PainChek
Invalid email address