The Highly Accurate PAINAD Scale: Pain Assessment in Advanced Dementia Scale
Written By Kobi Nathan, Pharm.D., M.Ed., CDP, BCGP, AGSF
Sleep Disorders
June 30, 2023

How to administer the PAINAD Scale

For those of you who want to get straight to the point, this is how you use the Pain Assessment in Advanced Dementia Scale (PAINAD):

  1. Observe your patient for 5 minutes in totality before scoring them on their five behaviors.
  2. Breathing: Normal (0); little labored breathing (1); Noisy labored breathing (2).
  3. Negative vocalization: None (0); Occasional moan (1); Loud moaning (2).
  4. Facial expression: Smiling (0); Sad (1); Frimacing (2).
  5. Body language: Relaxed (0); Tense (1); Rigid (2).
  6. Consolability: No need to console (0); Distracted (1); Unable to console (2).
  7. Total all scores above: 1-3 = Mild pain; 4-6 = Moderate pain; 7-10 = Severe pain

That’s all there is to it! Super simple! If you want to download the pdf and print the scale with instructions, you can do so here.

Important note: This pain assessment tool is specifically tailored for cognitively impaired patients.

For patients without dementia or cognitive impairment, the PQRST pain assessment method is a better option. You can read my article about it by clicking on the link.

Key Takeaways

  • PAINAD Scale is a comprehensive tool that assesses and manages pain in older adults with dementia and delirium in a hospital setting.
  • It focuses on observable signs of pain rather than patient self-report, making it particularly useful for individuals who cannot communicate their discomfort.
  • PAINAD Scale is part of a proactive approach to improve overall well-being and reduce the likelihood of undetected and untreated pain in dementia patients.
  • Incorporating the PAINAD Scale into routine patient assessments enhances the effectiveness of pain management plans and improves pain treatment outcomes.

The short 7-minute video below comprehensively describes the PAINAD scale and how you should score it:

Now, let’s delve into the details of the PAINAD scale… You’re likely aware of the challenges of assessing unrecognized and untreated pain in older adults suffering from advanced dementia, especially in a hospital setting.

This is especially true when signs show death is near for dementia patients.

Before you assess your patient for pain, it is imperative that you determine that your patient does not have reversible dementia, where other factors may be contributing to their cognitive impairment.

It’s an intricate task that requires keen observation and critical thinking, given that these individuals often struggle to communicate their discomfort.

Developed by Warden and colleagues in 2003, the PAINAD scale provides a consistent and reliable way for nurses and other healthcare professionals to assess and manage pain-related behaviors in patients with advanced dementia.

The tool is not just a simple checklist. It’s a comprehensive assessment that evaluates five key indicators of pain, offering a more holistic understanding of the patient’s condition.

But, to use it effectively, you need to understand its components and how to apply them correctly.

This article offers a detailed exploration of the PAINAD scale, its application, and its significance in healthcare.

By the time you’re done reading, you’ll have a deeper understanding of this vital tool and its potential to transform pain management in dementia patients.

What is the PAINAD scale?

The PAINAD scale can help you discern their discomfort by observing five subtle signs indicating pain and discomfort in your patients.

I will cover these signs in greater detail below.

As you know, pain in older adults with dementia often goes unnoticed due to their inability to express it verbally.

Therefore, the use of the PAINAD scale becomes indispensable in such scenarios.

Integrating the PAINAD scale into your routine patient assessments can help ensure that no patient’s pain goes unnoticed or untreated.

Remember, your critical thinking skills are essential in accurately using the PAINAD scale, making it an effective component of a comprehensive pain management plan.

When should the PAINAD scale be used?

So, when’s the right time to pull out this handy tool for assessing pain in our dementia and delirium patients?

The PAINAD scale should be used when the assessment of pain in patients with cognitive impairment is necessary.

Especially in older adults with dementia, the ability to communicate may be compromised, making traditional pain assessment tools less effective.

The PAINAD scale comes in handy as it focuses on observable signs of pain rather than self-reporting.

In elderly patients, untreated pain can lead to further cognitive impairment, worsening the symptoms of dementia and delirium.

Therefore, it’s crucial to use the PAINAD scale routinely, ensuring that signs of pain aren’t going unnoticed.

This proactive approach can make a significant difference in their overall well-being.

What are the 5 pain assessments in advanced dementia?

This scale assigns scores to five indicators of pain in patients with dementia:

  1. Breathing.
  2. Negative vocalization.
  3. Facial expression.
  4. Body language.
  5. Consolability.

Each of these five items provides a unique insight into the patient’s experience of pain.

Breathing irregularities, for example, could suggest discomfort, while negative vocalization can indicate distress.

Facial expressions often reveal hidden pain, and body language can hint at the location and intensity of the pain.

Lastly, consolability, or the patient’s ability to be soothed or comforted, can also shed light on the patient’s pain intensity.

How to use the PAINAD scale

To effectively use the PAINAD scale, you’ll need to observe each behavior and assign a score based on its intensity.

The total score will then give you an idea of the patient’s pain level.

Remember, this tool is not an isolated solution but is part of a comprehensive pain management plan.

It’s crucial to combine the use of this tool with your critical thinking skills to make informed decisions about the patient’s pain assessment and management.

The PAINAD scale is very user-friendly, intuitive, and organized to assess pain behaviors in your cognitively impaired patients.

The graphic below shows you what the scale looks like. You can immediately see how easy it is to assess your patient’s pain using this tool:



Concluding, it’s crucial to underscore the importance of effective pain assessment in older adults with dementia and delirium, particularly in a hospital setting.

The PAINAD scale, as an observational pain measure, serves as a valuable tool for identifying the presence of pain in individuals with dementia who may not be able to communicate their discomfort adequately.

This is especially notable in the case of nursing home residents who often struggle with chronic pain.

Without verbal communication, the risk of severe pain going unnoticed and untreated increases exponentially.

Thus, utilizing the PAINAD scale can significantly enhance the effectiveness of a comprehensive pain management plan for these individuals.

By doing so, you can ensure that the often-overlooked pain in individuals with dementia does not go unnoticed, ultimately improving their quality of life.

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