• T Hadjistavropoulos, M E Browne, K M Prkachin, B Taati, A Ashraf, and A Mihailidis.
• Department of Psychology, University of Regina, SK, Canada.
• Eur J Pain. 2018 May 1; 22 (5): 915-925.

BackgroundFine-grained observational approaches to pain assessment (e.g. the Facial Action Coding System; FACS) are used to evaluate pain in individuals with and without dementia. These approaches are difficult to utilize in clinical settings as they require specialized training and equipment. Easy-to-use observational approaches (e.g. the Pain Assessment Checklist for Limited Ability to Communicate-II; PACSLAC-II) have been developed for clinical settings. Our goal was to compare a FACS-based fine-grained system to the PACSLAC-II in differentiating painful from non-painful states in older adults with and without dementia.MethodWe video-recorded older long-term care residents with dementia and older adult outpatients without dementia, during a quiet baseline condition and while they took part in a physiotherapy examination designed to identify painful areas. Videos were coded using pain-related behaviours from the FACS and the PACSLAC-II.ResultsBoth tools differentiated between painful and non-painful states, but the PACSLAC-II accounted for more variance than the FACS-based approach. Participants with dementia scored higher on the PACSLAC-II than participants without dementia.ConclusionThe results suggest that easy-to-use observational approaches for clinical settings are valid and that there may not be any clinically important advantages to using more resource-intensive coding approaches based on FACS. We acknowledge, as a limitation of our study, that we used as baseline a quiet condition that did not involve significant patient movement. In contrast, our pain condition involved systematic patient movement. Future research should be aimed at replicating our results using a baseline condition that involves non-painful movements.SignificanceExamining older adults with and without dementia, a brief observational clinical approach was found to be valid and accounted for more variance in differentiating pain-related and non-pain-related states than did a detailed time-consuming fine-grained approach.© 2018 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation-EFIC®.

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