The Pain Assessment in Advanced Dementia (PAINAD) is a tool for healthcare professionals to evaluate pain in patients unable to communicate verbally. The scale scores five behavioral categories from 0 to 2 each, totaling 0 (no pain) to 10 (severe pain).
The Five Behavioral Categories of the PAINAD Scale
1. Breathing (Independent of Vocalization)
This category assesses changes in breathing patterns that may indicate pain. Observations include labored breathing, hyperventilation, or noisy respirations. Scores reflect the severity and frequency of these changes.
2. Negative Vocalization
Pain can be expressed through sounds like moaning, groaning, whining, or troubled calling out. The assessment notes the volume and tone of these vocalizations.
3. Facial Expression
The assessment monitors facial cues such as frowning, grimacing, or a pained expression. A tense or sad look, with more pronounced expressions receiving higher scores, is observed.
4. Body Language
Body posture and movements are observed for indicators like restlessness, rigidity, pacing, or guarding a body part. Fidgeting or resistance to care are also assessed.
5. Consolability
This component measures how easily the patient can be comforted or distracted. Difficulty in consoling the patient suggests greater pain.
PAINAD vs. Verbal Pain Scale: A Comparison
Comparing PAINAD to a verbal pain scale like the Numeric Rating Scale (NRS) highlights their different applications.
| Feature | PAINAD Scale | Verbal Numeric Rating Scale (NRS) |
|---|---|---|
| Patient Type | Non-verbal patients, especially those with advanced dementia or other cognitive impairments. | Patients capable of verbal communication and abstract thought. |
| Assessment Method | Observational, over a set period. | Self-reporting. |
| Measured Items | Breathing, negative vocalization, facial expression, body language, and consolability. | Subjective number from 0 to 10. |
| Scoring | Each of 5 categories scored 0-2; total score 0-10. | Single number from 0-10. |
| Reliability Concerns | Can overlap with other BPSD, requiring careful interpretation. | Requires cognitive capacity. |
| Best Use | For patients who cannot reliably self-report. | For cooperative and cognitively intact patients. |
The Clinical Application of PAINAD
Caregivers use PAINAD during routine care or when observing behavioral changes. A five-minute observation period is recommended. Repeated use helps track changes and assess pain management effectiveness. A cutoff score may suggest the need for intervention, but should be considered alongside other cues and the patient's baseline. Consistent application helps minimize undertreated pain.
The Importance of Comprehensive Pain Assessment
PAINAD is part of a broader pain assessment. Healthcare providers should consider medical history, including conditions that cause pain, and interview caregivers about the patient's usual pain expressions and recent behavioral shifts. Combining methods provides a clearer picture of pain for better management and quality of life.
Conclusion
What is assessed by the pain assessment in advanced dementia (PAINAD) includes observable non-verbal behaviors: breathing, vocalization, facial expressions, body language, and consolability. By standardizing these observations, PAINAD offers an objective way to evaluate pain in patients who cannot communicate verbally, enabling caregivers to address unrecognized pain, improve patient outcomes, and enhance quality of life. Consistent use of PAINAD along with other clinical data is vital for effective pain management in advanced dementia.
For more detailed guidance, including a downloadable PAINAD tool, see the HIGN Assessing Pain in Older Adults with Dementia guide.
