DOLOPLUS-2 (often written Doloplus-2) is an observational (proxy-rated) pain scale designed for older adults who cannot reliably self-report pain, commonly because of moderate–severe cognitive impairment. Instead of asking the patient to rate pain, a trained health professional (or caregiver familiar with the person) observes behaviors that may change when pain is present.

What it measures

The tool has 10 items, grouped into three domains (subscales):

Somatic reactions (5 items)

1. Somatic complaints
2. Protective body postures adopted at rest
3. Protection of sore areas
4. Facial expression
5. Sleep pattern

Psychomotor reactions (2 items)
6) Washing and/or dressing
7) Mobility

Psychosocial reactions (3 items)
8) Communication
9) Social life
10) Problems of behaviour

Scoring and interpretation

• Each item is scored 0 to 3 (0 = no change/behavior absent; 3 = marked change/behavior strongly present).
• Total score range: 0–30 (higher = more pain-related behaviors).
• The commonly used threshold is: ≥ 5 suggests pain is present (but pain cannot be fully ruled out below 5).

How it should be used (clinical tips)

• Use self-report first if the person can communicate reliably; DOLOPLUS-2 is mainly for non-verbal or poorly communicative patients.
• It’s intended to detect changes from the person’s usual behavior—so it works best when the rater knows the patient’s baseline, or can consult staff/family who do.
• The scale aims to score pain behaviors, not depression, dependency, or cognition (though in real life these can overlap—so clinical judgment matters).

Evidence and limitations (what to keep in mind)

Research shows generally good reliability, while validity findings are more variable, especially for some psychosocial items—so DOLOPLUS-2 should be used as part of a broader assessment (history, exam, likely pain sources, response to treatment).