• See Pain More Clearly Team

Using the PACSLAC-II Scale

The PACSLAC-II scale is an observational tool designed to help nursing staff evaluate pain in people with dementia who may have limited ability to communicate their pain verbally. “PACSLAC” stands for “Pain Assessment Checklist for Seniors with Limited Ability to Communicate”. The scale has been found to be both valid and clinically useful in pain assessment.


The PACSLAC-II does not use cut-off scores because scores are dependent on situational factors (e.g., how long was the person observed for; were they observed during rest or during a situations such as dressing or transferring) and on personal factors (e.g., for patients who cannot walk there may be a lower range of pain behaviours that could identified as compared to those who walk—if one does not walk, he or she will not limp). Instead of cut-off scores, we recommend that the PACSLAC-II be used regularly (i.e., at least once a week and more often if pain is suspected) with the scores recorded over time. Unusual changes in scores would likely be reflective of changes in levels of pain. If pain is suspected based on the PACSLAC-II, a health professional would need to evaluate the patient before the presence of pain can be confirmed. The health professional would also make decisions, following their examination of the patient, about appropriate courses of action.


The PACSLAC-II can be found on this website. In addition, we have created some guidelines to help clinicians assess pain both via self-report (where possible) or the PACSLAC-II. If the PACSLAC-II is used over time, it is should be used under similar circumstances (e.g., during physical therapy or while transferring) including similar durations of observation. It would not be appropriate to compare PACSLAC-II scores across different situations. Please review these guidelines carefully if you are a health professional interested in using the PACSLAC-II.


Although the PACSLAC-II is intended for use by qualified health professionals, initial research evidence suggests that lay people may be able to use the scale under the guidance and direction of a health professional. This could allow informal caregivers/family members working with health professionals, familiar with the PACSLAC-II and its administration guidelines, to help keep track of patient pain levels over time. The PACSLAC-II is not a substitute for physical examinations by qualified health professionals and is only a screening tool for pain. Like all other tools of its kind, under some circumstances it may fail to identify pain or may incorrectly signal pain when no pain is present.


How You Can Help?

Would you like to share your thoughts on our See Pain More Clearly initiative and the use of social media to mobilize knowledge about pain in dementia?

We are looking for health care professionals and others to participate in a study to evaluate the effectiveness of the #seepainmoreclearly social media initiative to mobilize knowledge about pain in dementia.

Find out more here



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