PAINAD (Pain in Advanced Dementia)

PAINAD (Pain Assessment in Advanced Dementia)

Observational five-item pain scale (breathing, vocalization, facial expression, body language, consolability) for adults with advanced dementia or cognitive impairment who cannot self-report; it supplements rather than replaces a verbal pain check when communication is possible.

Breathing (independent of vocalization)

0 - Normal 1 - Occasional labored breathing, short period of hyperventilation 2 - Noisy labored breathing, long hyperventilation, Cheyne-Stokes

Negative vocalization

0 - None 1 - Occasional moan or groan, low-level speech with negative or disapproving quality 2 - Repeated troubled calling out, loud moaning or groaning, crying

Facial expression

0 - Smiling or inexpressive 1 - Sad, frightened, or frowning 2 - Facial grimacing

Body language

0 - Relaxed 1 - Tense, distressed pacing, fidgeting 2 - Rigid, fists clenched, knees pulled up, pulling or pushing away, striking out

Consolability

0 - No need to console 1 - Distracted or reassured by voice or touch 2 - Unable to console, distract, or reassure