The assessment of pain in patients with a serious cognitive deficiency that prevents communication

Pain is a subjective experience that can be only evaluated by the own communication of patients who suffer it by means of valid, reliable and sensitive tools. In elderly people chronic pain is highly prevalent but frequently unattended. The evaluation of pain in this age group has several limitations, as many patients are affected of cognitive impairment that greatly limits their oral communication. In the last decade, new pain scales to evaluate pain in this group have been built. Most of them are not psychometrically acceptable because they did not accomplish the required requisites to be considered valid and reliable in clinical setting. Currently, the EDAD scale (Evaluación del Dolor en Ancianos con Demencia) has reported to be adequate from psychometric point of view. In this paper we report the general characteristics of these scales and a critical review of their use in cognitively impaired patients is included.