Pain is a subjective experience, which neither objective tests nor biological markers are able to measure (1). For this reason and whenever possible, the existence and intensity of pain are measured through self-reporting (2). However, in elderly adults or in those with dementia, cognitive functions deteriorate and patients become less likely to self-report pain, although there is no convincing evidence of clinically significant reductions in pain-related suffering (3). About 35.6 million people are estimated to be living with dementia worldwide, 7 million in Europe alone, which makes this syndrome a global health and social priority in high, middle and low-income countries (4). The detection and assessment of pain is the first step towards effective pain management in a vulnerable population. However, patients suffering from dementia or inaccurate in their self-reporting may be the reason why pain assessment and management may be difficult to achieve. The staff’s lack of pain management tools affects the ability to interpret what the patient is trying to express (5, 6). This inevitably leads to occurrences of inadequate pain care treatments. Pain management is a professional and ethical issue involving all healthcare professionals, whose objective is to relief the patient’s suffering. American Geriatrics Society suggested geriatric patients may be better assessed using a behavioral pain scale if they are unable to self report pain (7). Although over the last years several different instruments have been developed to measure pain in patients with dementia unable to self-report (8), no tool can truly be recommended across care settings and diverse population groups. Valid and reliable tools specifically organized to provide a cultural and linguistic evaluation of the patient are indeed the most recommended instruments to assess the pain experience (9). An original tool needs to be translated in a way comparable to the original, without altering the meaning and the aim for which the document has been produced (10).