CHAPTER 92: PAIN ASSESSMENT CHECKLIST FOR SENIORS WITH LIMITED ABILITY TO COMMUNICATE (PACSLAC)

Description

The Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) is an observational assessment designed to quantify the level of pain a person may be in and is particularly useful for individuals with a limited ability to communicate. The measure consists of 60 items covering various domains pertaining to (1) facial expressions, (2) activity/body, (3) social/personality, and (4) mood, as well as several other non-verbal indicators that also quantify pain levels. During assessment the clinician or caregiver completes the PACSLAC by observing the individual and noting whether any of the 60 items are present or observed by way of a checklist. Examples of behaviors included in the PACSLAC are grimacing, fidgeting, agitation, and shaking/trembling. Each item is scored as 1 point and the presence of higher scores is indicative of more pain descriptors and more severe pain. The assessment can be completed in less than 10 minutes and yields only a total standardized score; however, subscale scores are available for individual interpretation by the clinician.

Psychometrics

By comparing results from persons who experienced painful incidents Zwakhalen, Hamers, Abu-Saad, and Berger (2006) established high levels of internal consistency for total scores at α = 0.82 to 0.92, although Cronbach’s alpha values for the subscales were lower at 0.55 to 0.73. Also, the correlations calculated between Global Intensity Ratings and PACSLAC scores were moderate at r = 0.39 to 0.54. A study of 50 subjects with neurocognitive disorders of the dementia type who had a mean Mini Mental State Exam score of 7.5 showed that total PACSLAC scores ranged from 1 to 22 with a mean of 5.7 (SD = 4.0). Results also showed that the correlation coefficient was significant at 0.83 for scores rated by the researcher and those rated by caregivers (Cheung & Choi, 2008). A study of 40 raters who completed the PACSLAC relative to 2 situations during which a patient under their care experienced a clearly identifiable painful event (i.e., a fall or a painful medical procedure) found that results showed substantial correlations between those painful events at r = 0.39 for event 1 and r = 0.54 for pain event 2 (Fuchs-Lacelle & Hadjistavropoulos, 2004). The average total PACSLAC score for pain event 1 was 20.3 (SD = 7.5), and for pain event 2 it was 17.9 (SD = 8.3) (Fuchs-Lacelle & Hadjistavropoulos, 2004).

Advantages

The PACSLAC is easy to administer and is excellent for people with limited or no verbal skills making it particularly relevant for certain patient populations. It also does not require specialized training and can be completed in less than 10 minutes.

Disadvantages

There is a limited amount of supporting research pertaining to the PACSLAC. One reason for this might be the fact that it is a relatively newer assessment.

Administration

During assessment the clinician observes the subject and denotes the presence of any pain indicators as outlined on the assessment. In the form of a checklist, developers recommend that only the total score be interpreted, because reliability has been established for the whole assessment and not for the subscale scores (Hadjistavropoulos, Fitzgerald, & Marchildon, 2010).

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