Assessment Tool: PAINAD

Observe the patient for a set period (e.g. at rest and with care activities) and rate each of the five items. PAINAD is an observational tool and should supplement — not replace — clinical judgement and patient history.

Pain Assessment in Advanced Dementia (PAINAD)

A five-item observational pain assessment tool designed for non-verbal patients with advanced dementia. Total score 0–10. Developed by Warden, Hurley, and Volicer (2003). Score reflects observed behaviours over a specified observation period.

Interpretation guide

0–2

Mild / no pain

3–6

Moderate pain

7–10

Severe pain

Breathing

Independent of vocalisation

0 – Normal 1 – Occasional laboured breathing; short period of hyperventilation 2 – Noisy laboured breathing; long period of hyperventilation; Cheyne–Stokes respiration

Negative Vocalisation

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; frown 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

Result

PAINAD Score: 0/10

Pain level:

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