PAINAD

Pain Assessment in Advanced Dementia (PAINAD) is a behavioral pain assessment tool created for adults who are unable to communicate verbally, particularly those with advanced dementia or other cognitive impairments. The instrument consists of five observable indicators: breathing, negative vocalization, facial expression, body language, and consolability. Each item is scored on a 0‑2 scale, with 0 indicating no sign of pain and 2 indicating a strong sign; the scores are summed to produce a total pain score ranging from 0 to 10.

PAINAD was developed in the early 2000s by a team of clinicians and researchers seeking a reliable, quick method to assess pain in non‑verbal patients. Validation studies have shown that the scale has good inter‑rater reliability and concurrent validity when compared to established pain measures. It is routinely used in nursing homes, assisted‑living facilities, and acute care settings to guide medication management and interventions.

The scale’s simplicity allows staff to observe patients in routine activities or during specific triggers such as feeding or bed transfers. A high PAINAD score generally prompts clinicians to reassess analgesic plans, while lower scores can help avoid unnecessary medication. Over time, research has also examined the scale’s sensitivity to changes after therapeutic interventions, underscoring its role as both a diagnostic and monitoring tool for pain management in cognitively impaired populations.