Pain is one of the most under-recognized challenges in US long-term care, especially for residents living with dementia. As cognitive decline progresses, people often lose the ability to clearly describe what they are feeling.
For families and care teams, this creates uncertainty and distress: Is my loved one in pain? Are we doing enough?
Without reliable ways to detect pain, it can go unnoticed. Residents suffer in silence, and their families are left without answers. This is even harder in US long-term care, where staff shortages, time pressure, and residents with complex needs are everyday realities. In that environment, the subtle signs of pain are easily missed, or misread as behavioral symptoms of dementia.
For Kimberly Bergen-Jackson, a respected nurse researcher with a PhD, this gap in care has shaped decades of work.
She has led long-term care retirement communities as a Chief Operating Officer and Administrator, chaired the board of LeadingAge Iowa, and advised many organizations on state and national post-acute care policy. She is widely recognized for advancing quality and standards in post-acute and long-term care.
Her work has consistently focused on pain, functional decline, and quality of life in nursing home populations. That expertise made her uniquely placed to lead PainChek®’s pivotal US clinical study as Principal Investigator, a role that would directly influence how pain is assessed for people living with dementia across US long-term care.
“Research suggests that as many as 30 to 80% of nursing home residents with dementia experience untreated or undertreated pain,” Bergen-Jackson explains. “Because cognitive impairment limits a person’s ability to communicate discomfort, pain is often under-recognized, misinterpreted as behavioral symptoms, and inadequately managed. Once people lose the ability to say ‘I hurt,’ they often stop being assessed for pain.”
“People are treated for behavioral disorders when they actually have pain. You can treat behaviors with mental health medications but if that’s not the root of the problem, then you’re not really fixing anything. You’re just masking it, and it’s a struggle to find out what’s causing the problem.”
A clinically validated tool, built on years of research
PainChek® comes to the US with nearly a decade of clinical use behind it. The technology originated from academic research at Curtin University in Western Australia, and has been used in everyday care since 2017. In that time, clinicians have completed more than 20 million pain assessments across 2,000+ organizations in Australia, New Zealand, the UK and Canada.
The US study was a deliberate next step: a full clinical study conducted on American soil, designed to meet the standards US regulators require. That study supported PainChek®’s FDA De Novo classification, the pathway the FDA uses to authorize a new type of medical device.
Leading a landmark US clinical study
The study tested PainChek®’s AI-enabled medical device for pain assessment across skilled nursing facilities in Iowa and New York. It involved 105 residents of diverse ages and skin tones, with varying degrees of cognitive impairment, which confirmed the device could be reliably used across the broad range of demographic subgroups commonly seen in US long-term care.
The research was conducted by a team of nurse researchers, clinicians, and academic investigators. Their aim was to collect the clinical evidence needed to support FDA De Novo classification, and confirm that PainChek® could reliably and safely assess pain in people who can’t self-report, under real-world US nursing home conditions.
This evidence was critical to showing that the technology met the FDA’s standards for a new type of medical device, enabling it to be used across US long-term care facilities.
Staff across participating facilities were trained on PainChek®’s AI-enabled facial analysis and observational assessment features, ensuring safe and effective use in real-world conditions. Bergen-Jackson shares:
“For nursing home providers considering PainChek®, it’s important to know that actual long-term care nurses participated in the study and had a positive response. We dealt with COVID, RSV, influenza, residents who passed away, nursing homes being sold…so the study had real-world credibility.”
Key findings and implications
Findings from the study showed that PainChek® is a valid and reliable tool for assessing pain in residents who cannot self-report. Key results included:
- PainChek® scores matched well with the internationally recognized Abbey Pain Scale
- Different caregivers produced similar results when using PainChek®, demonstrating greater consistency than traditional pain assessment methods
- PainChek® worked reliably for residents of different ages, ethnicities, races, genders, and stages of dementia
Bergen-Jackson also notes an important clinical insight that emerged during the research:
“An interesting finding we came upon from conducting PainChek® pain assessments during the study was that people were much more painful after movement. It makes sense when you think about it: someone with joint pain might be comfortable at rest, but as soon as they’re moved, the pain becomes evident. I think this is very significant and it suggests we should change the way we evaluate pain, assessing people not just at rest, but after movement.”
This observation highlights a broader shift in how pain assessment could be approached in long-term care, underscoring the need to evaluate residents following activity as well as at rest.
Looking ahead
By giving clinicians and caregivers clear, objective pain assessment at the point of care, PainChek® changes how pain is recognized and managed, giving a voice to those who cannot reliably verbalize their pain.
The full clinical findings from the US study are being prepared for publication in a peer-reviewed journal, expected in 2026.
References
1. Resnick B, et al. “Pain Assessment and Management Among Nursing Home Residents Living With Dementia,” Pain Management Nursing (2025). Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12354327/
