Pain Assessment in Advanced Dementia (PAINAD) Scale

Evaluates degree of pain in patients with dementia based on patient behavior in 5 categories.

Refer to the text below the scale for more information about pain assessment in the context of advanced dementia.


The Pain Assessment in Advanced Dementia Scale (PAINAD) scale has proven to be a reliable tool for pain evaluation in dementia patients. The original study defines scores between 0 and 10, where 0 means “no pain” and 10 means “severe pain”.

The scale has been validated in varying levels of cognitive impairment but there is no definitive evidence regarding its correlation with self-reported gradations of pain.


PAINAD items include descriptions of:

  • Breathing (independent of vocalization);
  • Negative vocalization;
  • Facial expression;
  • Body language;
  • Consolability.

Scores range from 0 to 10, where the higher the score, the more severe the degree of pain:

PAINAD Score Pain Assessment
0 - 3 Mild pain
4 - 6 Moderate pain
7 - 10 Severe pain

1

Breathing (independent of vocalization)

2

Negative vocalization

3

Facial expression

4

Body language

5

Consolability

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Pain Assessment in Dementia Patients

The Pain Assessment in Advanced Dementia Scale (PAINAD) scale has proven to be a reliable tool for pain evaluation in dementia patients. The original study defines scores between 0 and 10, where 0 means “no pain” and 10 means “severe pain”.

The scale has been validated in varying levels of cognitive impairment but there is no definitive evidence regarding its correlation with self-reported gradations of pain.

The scale administrator is asked to observe the patient for five minutes, either at rest, during a relaxing activity, during caregiving activities or administration of pain medication.

PAINAD items include descriptions of:

  • Breathing (independent of vocalization)
  • Negative vocalization
  • Facial expression
  • Body language
  • Consolability

Scores range from 0 to 10, where the higher the score, the more severe the degree of pain, but the following score groupings can also apply:

PAINAD Score Pain Assessment
0 - 3 Mild pain
4 - 6 Moderate pain
7 - 10 Severe pain

During the original study by Warden et al. 19 dementia patients were observed by a principal investigator and two other raters. The PAINAD correlated well with the Discomfort Scale-Dementia of Alzheimer Type.

Good interrater reliability was observed, as well as a statistically significant decrease in score after administration of analgesics. Pain should be assessed serially and caution should be exerted when titrating medicine.

 

References

Original reference

Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc. 2003; 4(1):9-15.

Validation

Hutchison RW, Tucker WF Jr, Kim S, Gilder R. Evaluation of a behavioral assessment tool for the individual unable to self-report pain. Am J Hosp Palliat Care. 2006; 23(4):328-331.

Mosele M, Inelmen EM, Toffanello ED, et al. Psychometric properties of the pain assessment in advanced dementia scale compared to self assessment of pain in elderly patients. Dement Geriatr Cogn Disord. 2012; 34(1):38-43.

Other references

DeWaters T, Faut-Callahan M, McCann JJ, et al. Comparison of self-reported pain and the PAINAD scale in hospitalized cognitively impaired and intact older adults after hip fracture surgery. Orthop Nurs. 2008; 27(1):21-28.


Specialty: Pain Management

Objective: Assessment

Year Of Study: 2003

Abbreviation: PAINAD

Article By: Denise Nedea

Published On: August 31, 2020

Last Checked: August 31, 2020

Next Review: August 31, 2025