There has yet to be an overall agreement on which scale is best. Scales have been created without the reference of relevant research. Their evidence is questionable as their measures have not been proven to be pain specific. 


The Problem with Pain Scales 

Cedarville University

To analyze pain responses, a researcher can utilize assistive technology to conduct acoustic analysis of spontaneous vocalization

Using Assistive Technology to Measure Pain in Individuals with Severe Intellectual Disability

Barney, C. C., Andersen, R. D., Defrin, R., Genik, L. M., McGuire, B. E., & Symons, F. J. (2020). Challenges in pain assessment and management among individuals with intellectual and developmental disabilities. Pain reports, 5(4), e821. https://doi.org/10.1097/PR9.0000000000000822

Challenges in pain assessment and management among individuals with intellectual and developmental disabilities


Implementing alternative methods does not allow researchers to establish pain thresholds, but it gives them a way to compare physiological responses of those with varying levels of disability.

Effectiveness of Utilizing Alternative Approaches to Measure Pain in Individuals with Severe Intellectual Disability



In populations of individuals with intellectual disability, pain scales may be adapted. A visual adaptation such as pictures like faces or pyramid scales may be used or physical items like blocks.

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