The Pain Assessment in Advanced Dementia (PAINAD) scale is a behavior tool used to assess pain in older adults who have dementia or other cognitive impairment and are unable to reliably communicate their pain.
It should be used:
• at initial intake/admission to services.
• for an older adult with behavioral symptoms suggestive of pain—assess at least every 8 hours.
• anytime a change in pain status is reported.
• 1 hour following a pain intervention, to assess effectiveness.
The scale monitors 5 categories of pain-related behaviors
1. Breathing (independent of vocalization)
Normal = 0
Occasional labored breathing or short periods of hyperventilation = 1
Noisy labored breathing, long periods of hyperventilation, or Cheyne-Stokes respirations = 2
2. Negative vocalization
None = 0
Occasional moan/groan or low-level speech with negative quality = 1
Repeated troubled calling out, loud moaning or groaning, crying = 2
3. Facial expression
Smiling or inexpressive = 0
Sad, frightened, frown = 1
Facial grimacing = 2
4. Body language
Relaxed = 0
Tense, distressed pacing/fidgeting = 1
Rigid, fists clenched, knees pulled up, pulling, pushing away, striking out = 2
No need to console = 0
Distracted or reassured by voice or touch = 1
Unable to console, distract, or reassure = 2
How to use
• Observe the older adult for 3-5 minutes during activity (with movement, i.e., bathing, turning, transferring).
• For each item included in the PAINAD, select the score (0, 1, 2) that signals the current state of the behavior.
• Add the score for each item to achieve a total score. Total scores range from 0 to 10 (based on a scale of 0 to 2 for the five behaviors).
After each use, the total score must be compared to a previous score. An increased score suggests an increase in pain, while a lower score suggests pain is decreased.
See reference for more information.
Adapted from Warden, V, Hurley AC, Volicer, V. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) Scale. J Am Med Dir Assoc 2003; 4(1): 9-15.