Pain Assessment in the Communicatively Impaired person

Pain Assessment in the Communicatively Impaired person

Life & Death Matters Post

In another study by Kaasalainen et al (*see reference below) a tool was developed to screen for pain among individuals who are not able to communicate the presence of pain. The tool “Pain Assessment in the Communicatively Impaired” person (PACI) is shown to be reliable and valid.  It can be recommnded for clinical use, and can be used to screen for pain by Health Care Workers.  Then a more comprehensive pain assessment can/should follow.

The PACI observes

Facial expressions:

  • Brow lower
  • Lid tighten
  • Cheek raise


  • Sounds
  • Words

Body language:

  • Guarding
  • Rub/touch

In the “Essentials in Hospice Palliative Care” text, the PAINAD scale is presented.  Similar items are observed: breathing, negative vocalization, facial expression, body language and consolability. The PAINAD is not intended to identify the SEVERITY of pain, but to detect pain, and encourage a further assessment.

Most useful is the fact that Health Care Workers can screen for pain, report their assessment, and request a further assessment be completed. With Health Care Workers providing the majority of direct care in Long Term Care we need to encourage and strengthen their ability to contribute to assessment, and encourage nurses to collaborate with them in providing and planning care.

I came upon this article by reading about the research  “Quality Palliative Care in Long Term Care”   This is great research. So applicable to the course that Deb Ribeyre is teaching in the LDM Online program in November.  “Loss Grief and Dying with Dementia”

See article: Development and evaluation of the Pain Assessment in the Communicatively Impaired (PACI) tool: part II.Full Text Available (includes abstract); Kaasalainen, Sharon; Stewart, Norma; Middleton, Joan; Knezacek, Sandy; Hartley, Terry; Ife, Christie; Robinson, Lara; International Journal of Palliative Nursing, 2011 Sep; 17 (9): 431-8

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Courtney Murrell is a PSW who works in hospice palliative care.

When she is not at work, she is spending time with her family, going on hikes or writing. Courtney is a lifelong learner and loves to share her passion for writing as a wellness practice.

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