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This article has been double-blind peer reviewedIn this article…Scales and observational tools for pain assessmentPrinciples of pain assessment in people with cognitive impairmentThe Bolton Pain Assessment ToolPain is a subjective experience that is difficult to assess. The difficulty is compounded in patients who cannot communicate their experience verbally - for example due to cognitive impairment. In such patients, health professionals rely on the observation of behaviour to assess pain. In trauma and orthopaedic settings, an added difficulty is that staff are not familiar with patients and so find it difficult to identify behaviour indicative of pain. This article, the first in an occasional series on orthopaedic nursing, covers pain assessment in trauma and orthopaedic patients with a focus on pain assessment scales and observational tools, including the Bolton Pain Assessment Tool.