Pain Assessment in Advanced Dementia (PAINAD) scale

Items*	0	1	2	Score
Breathing independent of vocalization	Normal	Occasional labored breathing. Short period of hyperventilation.	Noisy labored breathing. Long period of hyperventilation. Cheyne-Stokes respirations.
Negative vocalization	None	Occasional moan or groan. Low-level speech with a negative or disapproving quality.	Repeated troubled calling out. Loud moaning or groaning. Crying.
Facial expression	Smiling or inexpressive	Sad. Frightened. Frown.	Facial grimacing.
Body language	Relaxed	Tense. Distressed pacing. Fidgeting.	Rigid. Fists clenched. Knees pulled up. Pulling or pushing away. Striking out.
Consolability	No need to console	Distracted or reassured by voice or touch.	Unable to console, distract, or reassure.
Total^¶:

This pain assessment score can be used to assess pain in patients with dementia. Patients should be observed for 5 minutes prior to performing the assessment. Total scores range from 0 to 10, with 10 representing severe pain.

* 5-item observational tool.
¶ Total scores range from 0 to 10 (based on a scale of 0 to 2 for 5 items), with a higher score indicating more severe pain (0 = "no pain" to 10 = "severe pain").

Original figure modified for this publication. 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; 4:9. Illustration used with the permission of Elsevier Inc. All rights reserved.

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