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Pain experiences vary in cause, severity, and duration, but using technology facilitated by AI has the potential to help clinicians assess and manage pain more efficiently and effectively for thousands of people across the globe.

This blog discusses the issue of persistent or recurring pain affecting aged care residents, including the reasons behind under-treatment and the efficacy of existing pain assessment tools. We explore how the use of medical technology, such as PainChek®, is helping to improve outcomes for clinicians and residents.

Pain is common but often undertreated

Research from the Hartford Institute for Geriatric Nursing shows persistent or recurring pain affects many people aged 65 and older but is often undertreated. Lack of routine pain assessment is one of the important contributing factors.

Functional impairment, falls, prolonged rehabilitation, depression, anxiety, reduced social interaction, poor sleep, and increasing healthcare costs can all contribute to pain that can impair activities of daily living. With an ageing population across the globe, the need for reliable pain assessment tools will continue to grow.

Existing pain assessment tools

Pain assessment in aged, acute, long-term care and community environments usually relies on a person’s self-report in order to identify and ascertain their level of pain.
In these cases, tools such as the Numeric Rating Scale (NRS) are used and the person is asked to rate pain intensity on a scale from 0 to 10 (where 0 is no pain and 10 is the worst pain imaginable).

The NRS is one of the most commonly used pain scales and is generally considered the gold standard of pain assessment in those who can self-report.

For those who are unable to self-report, there are many observational pain assessment tools, of which a number of them are commonly used by carers and clinicians, including:

  1.  Abbey Pain Scale – Considers six areas which include vocalisation, facial expressions, change in body language as well as behavioural, physiological and physical changes. A rating from 0-3 is given for each area and a final score is tallied from the cumulative results.
  2. Checklist of Non-verbal Pain Indicators (CNPI) – Also measures pain behaviours in cognitively impaired older adults who are unable to communicate. The six-item checklist includes nonverbal vocal complaints, facial grimaces and winces, bracing, restlessness, rubbing and verbal complaints.
  3. Pain Assessment Scale for Seniors with Severe Dementia (PACSLAC) – A comprehensive tool with a total of 60 items spread across five subscales: facial expression, activity and body movement, social personality and mood, and “other” (such as changes in appetite, sleep, vocalisations etc.)
  4. Pain Assessment in Advanced Dementia Scale (PAINAD) – Involves observation of the resident during brief activity or movement, before scoring across five domains: negative vocalisations, body language, breathing, facial expression and consolability.

Technology and a human-centred solution

The PainChek® app is a hybrid tool that uses AI to assess facial indicators of pain before digitally combining this result with other non-facial indicators of pain. The PainChek® solution involves digital analytics and education in addition to the App, and is already in use throughout more than 1,000 aged care facilities across Australia, New Zealand, the United Kingdom, and Canada.

Since its first use in 2017, the PainChek® tool has gained strong adoption for its ability to provide clinicians and those in their care with fast, reliable and consistent pain assessment, measurement, and data reporting.

How it works

  1. A smart device camera using AI examines nine facial indicators of pain. These facial indicators of pain are detected in real time and recorded on a personalised dashboard within the app.
  2. The assessor then reviews and scores pain indicators in a further five non-facial pain domains: voice, movement, body, behaviour, and activity.
  3. A pain severity rating ranging from no pain, mild, moderate to severe is generated and recorded in the dashboard.
  4. The app also incorporates the NRS pain score method for when the resident is able to self-report. This allows for cross-referencing between the app’s analytics and each person’s self-reported pain levels and mitigates against fragmentation of residents’ documentation of pain.

PainChek® enables consistent pain assessment for those who cannot reliably self-report (e.g. those living with moderate to severe dementia), those who can, and those who fluctuate between the two.

PainChek® also leads to potentially wider benefits within the care setting. Clinicians can quickly and easily access pain assessment reports through PainChek’s digital analytics capability. The data is consistent regardless of the clinician, changing staff members, or the person’s location. PainChek®’s use supports best-practice pain management whilst enabling consistent and ongoing documentation of pain.

PainChek® also eliminates the need for paper based systems and files, which are labour intensive, can be misplaced, and potentially contain conflicting or inconsistent information.

Benefits for clinicians and residents

PainChek® facilitates communication and collaboration between different disciplines. In a recent report by KPMG, 83% of respondents said sharing results led to a change in treatment plan, including medical prescription. This multidisciplinary data-sharing approach helps to improve overall pain management and ensures that pain assessments are consistent across different caregivers and time points.

PainChek® is fast to use, reliable and contributes towards objectivity during the pain assessment process. The tool uses AI to automatically analyse and detect facial indicators of pain, which can be difficult to interpret for some caregivers and is associated with subjectivity. This approach helps to ensure that pain assessments are more consistent and less subjective.

PainChek® supports compliance with quality standards for pain management, including the Aged Care Quality Standards. PainChek® can help clinicians to detect and manage pain more effectively, leading to improved quality of life for residents.

By providing an accurate and more objective assessment of a resident’s pain levels, clinicians can avoid inappropriate medication use, reduce the risk of medication-related complications and improve overall resident outcomes.

Pain assessment in aged care

Aged care establishments that have implemented PainChek® already report significant benefits from using PainChek in clinical practice.

A recently published peer reviewed paper examined the use of PainChek® within the Reconnect program as part of Orchard Care Homes quality improvement program. The use of PainChek® supported the aim of improving pain identification and management, and the following outcomes were identified:

≈ 27% reduction in reported distress (i.e. distress responses per resident reduced from 14.5 to 10.6 events)
= 50% reduction in ‘when required’ use of benzodiazepines (i.e. from 6 months average of 46 to 23.2 doses given). Dose reductions and benzodiazepine cessations increased significantly as well.
= 26% reduction in use of antipsychotics (i.e. a reduction from 76.3 to 56.3% in antipsychotic use).
= 92% reduction in reported safeguarding events

The Allambie Heights Village Residential Aged Care Facility in Australia reported PainChek® data helped reduce the need for psychotropic medications by providing more accurate reporting to GPs about the link between untreated pain and challenging behaviour in residents.

PainChek® data also demonstrated the importance of establishing the right medication based on individual circumstances. This in turn improved staff confidence in identifying pain and administering medication.

The Charlotte James care home in the UK, which specialises in dementia, reported a reduction in falls and psychological symptoms due to better pain management following PainChek®’s introduction.

St Louis Aged Care in Adelaide, Australia, replaced paper based pain assessments with PainChek®. It is now their standard tool for pain assessment for all residents regardless of their ability to self-report. Due to its ease of use, and time and admin saving features, staff now have more time to spend providing meaningful care to residents.

If you are interested in learning more about PainChek® and how it can be integrated with your existing care systems, book a one-on-one session with a member of our team.


1Dr Flaherty, Ellen, ‘Pain Assessment for Older Adults, Hartford Institute for Geriatric Nursing, https://hign.org/consultgeri/try-this-series/pain-assessment-older-adults
2Carrington Reid M, Eccleston C, Pillemer K, ‘Management of Chronic Pain in Older Adults’ BMJ 2015;350:h532
3Natavio T, McQuillen E, Dietrich MS, Wells N, Rhoten BA, Vallerand AH, Monroe TB. A comparison of the pain assessment checklist for seniors with limited ability to communicate (PACSLAC) and pain assessment in advanced dementia scale (PAINAD). Pain Management Nursing. 2020;21(6):502-9.
4Baird C, Miller H, Hoti K, Hughes J, ‘Clinical impact of a multifaceted intervention aimed at decreasing distress in people living with dementia: evaluating the Reconnect program’ Frontiers in Psychiatry. 2023;14.

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