Literature and development

of the PAIC 15 scala

In 2011, the EU-funded COST Action TD1005, chaired by Prof. S. Lautenbacher (University of Bamberg, Germany) and Prof. W. Achterberg (Leiden University, The Netherlands), started to develop a scale to measure pain in people with cognitive impairments (especially dementia).

In total, around 60 scientists from 16 European countries and from different disciplines (nursing, medicine, psychology, physiotherapy, and epidemiology) participated in this combined effort. In the period from 2011 to 2018, a large number of experimental and clinical studies were carried out in the different member countries of the COST Action. The aim of the studies was to extract from existing pain observation scales those items that are best suited to detect pain in people with dementia.

You can find more detailed information on the developmental process of the PAIC 15 scale and its psychometric properties below.


Developmental process and psychoemtric properties:

Corbett, A., Achterberg, W., Husebo, B., Lobbezoo, F., de Vet, H., Kunz, M., Strand l, Constantinou M, Tudose C, Kappesser J, de Waal M & Lautenbacher S. (2014). An international road map to improve pain assessment in people with impaired cognition: the development of the Pain Assessment in Impaired Cognition (PAIC) meta-tool. BMC neurology, 14(1), 229.

van Dalen-Kok, A. H., Achterberg, W. P., Rijkmans, W. E., Tukker-van Vuuren, S. A., Delwel, S., de Vet, H. C., Lobbezoo, F., de Waal, M. W. (2018). Pain Assessment in Impaired Cognition (PAIC): content validity of the Dutch version of a new and universal tool to measure pain in dementia. Clinical Interventions in Aging, 13, 25-34. doi:10.2147/cia.S144651

van Dalen-Kok, A. H., Achterberg, W. P., Rijkmans, W. E., de Vet, H. C., & de Waal, M. W. (2019). Pain assessment in impaired cognition: observer agreement in a long-term care setting in patients with dementia. Pain management, 9(5), 461-473.

 de Waal, M. W., van Dalen‐Kok, A. H., de Vet, H. C., Gimenez‐Llort, L., Konstantinovic, L., de Tommaso, M., Fischer, T., Lukas, A., Kunz, M., Lautenbacher, S., Lobbezoo, F., MCGuire, B.E., van der Steen, J.T., Achterberg, W.P.  (2019). Observational pain assessment in older persons with dementia in four countries: observer agreement of items and factor structure of the Pain Assessment in Impaired Cognition. European Journal of Pain.

Kunz M, de Waal M, Achterberg WP, Gimenez-Llort L , Lobbezoo F, Sampson EL, van Dalen-Kok AH, Defrin R, Invitto S, Konstantinovic L, Oosterman JM, Petrini L,  van der Steen JT, Strand LI, de Tommaso M, Zwakhalen S, Husebo BS, Lautenbacher S (2019). The Pain Assessment in Impaired Cognition scale (PAIC-15): a multidisciplinary and international approach to develop and test a meta-tool for pain assessment in dementia. European Journal od Pain,

Kappesser J, Voit S, Lautenbacher S, Hermann C (2020). Pain assessment for cognitively impaired older adults: do items of available observer tools reflect pain‐specific responses?. European Journal of Pain,

Laekeman M (2020) Den Schmerz von Menschen mit Demenz erfassen – Pain Assessment in Impaired Cognition Scale (PAIC 15). physiopraxis, 18(06): 52-53. DOI: 10.1055/a-1191-8688

Giménez-Llort L, Bernal ML, Docking R, Muntsant-Soria A, Torres-Lista V, Bulbena A and Schofield PA (2020). Pain in Older Adults With Dementia: A Survey in Spain. Frontiers in Neurology

First applications in research:

Lautenbacher, S., Walz, A. L., & Kunz, M. (2018). Using observational facial descriptors to infer pain in persons with and without dementia. BMC geriatrics, 18(1), 88.

Oosterman, J. M., Traxler, J., & Kunz, M. (2016). The influence of executive functioning on facial and subjective pain responses in older adults. Behavioural Neurology, 2016.

Lautenbacher, S., Sampson, E. L., Pähl, S., & Kunz, M. (2016). Which facial descriptors do care home nurses use to infer whether a person with dementia is in pain?. Pain Medicine, 18(11), 2105-2115.

van der Steen, J. T., Sampson, E. L., Van den Block, L., Lord, K., Vankova, H., Pautex, S., … & de Vet, H. C. (2015). Tools to assess pain or lack of comfort in dementia: a content analysis. Journal of pain and symptom management, 50(5), 659-675.