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In modern palliative medicine adequate and rapid pain assessment in nonverbal elderly patients with severe dementia is one of the key issues. With increasing severity of dementia patient-surrounding communication becomes more challenging and verbal assessment of the pain -less accurate. In patients with severe dementia, it is necessary to find different approach, like observational and surrogate assessment methods. There are multiple observational methods of assessment, which are based on nonverbal behavior (facial expression, paralinguistic sounds, tension, anxiety, changes in social behavior, sleep habit changes, aggressiveness, change in psycho-motor activation etc.) Article shows pain assessment scales used more frequently in clinical practice. Pain management in patient with dementia depends on the proper assessment of pain intensity. Pain assessment scales available for us, gives us ability to adequately and in a timely manner assess presence of the pain and its intensity.