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The aim of this review was to investigate the tools used to identify pain in patients who are non-communicative and therefore unable to communicate pain to their caregivers. A systematic review of the studies published with predetermined eligibility criteria was undertaken. A total of 32 studies were identified and reviewed. Among the articles included, we observed two different types of outcome measures: physiological and behavioral measurements. Eleven articles referred to physiological measurements and 20 referred to behavioral measurements, with one article referring to both types of measurements. All the papers described at least one instrument or measure, which was implemented to measure pain in non-communicative patients. The results confirmed the agreement among behavioral measurements of pain, while physiological measurements should be studied more in depth. This review suggests that the use of frequent items in each scale and in each physiological instrument may help healthcare professionals and caregivers to overcome the barrier of prognosis uncertainty and to identify patients that could benefit from their use. [ABSTRACT FROM AUTHOR]