The Doloplus Scale

Behavioral pain assessment scale for the elderly presenting with verbal communication disorders, DOLOPLUS consists in an observation form consisting of 10 items divided into 3 sub-groups proportionally to the observed frequency (5 somatic items, 2 psychomotor items and 3 psychosocial items).

Each item is scored from 0 to 3 (scored using 4 exclusive and progressive levels) yielding an overall score between 0 and 30.

Pain is patent for a score greater than or equal to 5 out of 30.

DO NOT AUTOMATICALLY USE THE DOLOPLUS SCALE WITHOUT FIRST TRYING SELF-ASSESSMENT.

When the elderly person can communicate and cooperate, it makes sense to use self-assessment tools.
Combining self- and hetero-assessment will avoid underestimation.

RATING OF AN ITEM IN ISOLATION

This is pointless; it is the overall score which matters. But if it is concentrated on the last items, pain is unlikely.

ITERATIVE

Behaviour is iterative if it is repeated several times (therefore not continuously)

AN APPROVED SCALE​

The use of a scale which has not been approved or which includes poor psychometric properties will lead to erroneous extrapolation. Thus any measuring instrument, if it is to be of any practical use, must be approved. This means checking that it provides a sensible, reproducible, reliable and specific result.
Before using a tool, the clinician must be satisfied that it has good psychometric qualities (see Hadjistravopoulos et al. 2006).

The Doloplus scale is the first hetero-assessment scale of pain in elderly people with verbal communication difficulties to have been approved in French in January 1999 and published (Lefebvre- Chapiro 2001). Fifteen French and Swiss geriatricians trained in palliative care and pain management, led by a biostatistician, studied a population of elderly subjects aged over 65 and having verbal communication or behavioural difficulties, except when studying convergent validity (in which case the ability to self-assess was required). This was a multicentre study (15 different centres with or without geriatric medicine units, palliative care departments, geriatric aftercare and long-term care centres, geriatric rehabilitation centres and care homes). It began in March 1995 and ended in January 1999.

The 510 elderly people were aged between 65 and 101, and were assessed using the Doloplus scale 1 to 3 times depending on the tests, making a total of 1000 assessments. The various statistical validation stages concentrated on the study of reproducibility (test-retest reliability and inter-rater reliability), sensitivity (by item and overall), convergent validity and internal consistency.

For more detailed numerical data, please see the following publication:
Wary B.,Serbouti S., “Doloplus: validation d’une échelle d’évaluation comportementale de la douleur chez la personne âgée.” Revue Douleurs, 2001, 2; 1: 35-38.
The days of simple estimation of pain are behind us. Today’s hetero-assessment scales have filled in the gaps which self-assessment tools were unable to fill. Validation of the Doloplus scale is just one more battle won in the fight against the inequalities to be found in pain management, particularly in elderly people with verbal communication difficulties.

YOUR QUESTIONS

Below are some of the most frequently asked questions about DOLOPLUS.
If, after exploring this site and particularly the recommendations given, you still have questions about how to use the scale, or if you would like any further information, whether it is about international development, approval of the scale, or anything else, please get in touch with the appropriate person via the “Contact us” section.

WHO SCORES, AND HOW FREQUENTLY?

Any change in behaviour should be seen as a possible indication of pain, and so any caregiver may need to carry out a behavioural assessment. The tool is not for use by doctors alone, and a multidisciplinary approach is wisest. Assessment should be carried out at least once daily until the pain is sedated, and then at longer or shorter intervals if the behaviour stabilises. It is important to compile score kinetics.

CAN A SOLE CAREGIVER AT HOME USE DOLOPLUS?

Scoring by a pluridisciplinary team is preferable, but use by lone caregivers is possible (still wiser than simple estimation).
It is essential to draw on information gathered from the family and other persons involved (liaison notebook, telephone conversation, scheduled bedside meeting).

HOW LONG DOES SCORING TAKE?

Geriatric caregivers are specialists in assessment, and they often have a comprehensive toolbox at their disposal. Such tools include the Folstein Mini Mental Status Examination, bladder diary, dependency grids, Hamilton rating scale, Karnowski performance scale, pain self-assessment scales etc. Hence the initial reluctance to make the list longer. For “trained” caregivers, the time taken for scoring ranges from 2 to 5 minutes maximum. If that leads to the pain being managed, then it represents hours of groans, shouts, agitation and painstaking care avoided. The benefit is obvious.

IS THERE A LINK BETWEEN THE DOLOPLUS SCORE AND WHICH PAINKILLER TO PRESCRIBE?

A pain rating scale only answers one question: “Is this elderly person in pain or not?” The prescription of a painkiller should be kept separate from the assessment score; experience of pain is purely personal, and only score kinetics will tell us whether the painkilling treatment is adequate or not.

CAN THE DOLOPLUS SCALE BE USED FOR OTHER POPULATIONS?

The DOLOPLUS scale has its limitations and it is best to give the patient the benefit of the doubt. Where scores are in the range of 1 to 4/30, conduct an analgesic-focussed pharmacological test. The use of other tools to identify an aetiology other than pain for observed changes in behaviour, test treatments and repeated pluridisciplinary assessments are very valuable in establishing the most appropriate diagnosis possible.

Peut-on utiliser l'échelle DOLOPLUS pour d'autres populations ?

Non, mais… Il n’existe actuellement pas d’échelle comportementale pour évaluer la douleur chez l’adulte psychiatrique ou comateux par exemple. 
Les comportements étant assez spécifiques d’une population donnée, il faudrait réserver l’échelle DOLOPLUS aux malades âgés. 
Si l’absence d’outil d’hétéro-évaluation pour d’autres populations autorise l’utilisation quelque peu abusive de DOLOPLUS, elle doit surtout inciter à la recherche d’outils adaptés à chaque type de population.

DOES DOLOPLUS SCORE ACUTE PAIN?

It is designed more for chronic pain conditions. However, in suspected cases of acute pain, where there is a zero score on the Algoplus scale, it is advisable to carry out a Doloplus scale assessment to avoid failing to recognise chronic pain. The algorithm which couples the two scales can be viewed on the website.

CAS CLINIQUES

Les cas cliniques sont classés par ordre de difficultés croissantes en fonction de l’apprentissage réalisé.

Télécharger le fichier PDF de chaque cas clinique.

Learning how to use the DOLOPLUS scale

Over the last three days, Mr D’s behaviour had changed. Mr D., aged 87, had been a resident in a Long-Term Geriatric Care Unit for five years, since losing his wife. He had been suffering from Alzheimer’s-type dementia for seven years by then and had no other known health conditions.
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Pain versus depression

Mrs R, aged 82, was admitted to a short-term care unit at the Geriatrics Centre for reduced autonomy and treatment of pressure ulcers.
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ALGOPLUS and DOLOPLUS

Mrs K, aged 86, a widow, was described as being an active woman, and belonged to a number of associations in her village. Sadly, over the course of the summer, her family noticed a change in higher functions, with memory problems, behavioural problems and episodes of confusion; this was combined with coordination problems, particularly when walking.
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ALGOPLUS and DOLOPLUS

Mrs Y, aged 89, with a medical history of polyvascular disease against a background of type 2 diabetes detected 2 years previously, had recently suffered an infarctus resulting in partially regressive stroke with resulting dysarthria and confusion.
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