Pain Assessment in Advanced Dementia Scale (PAINAD)

Why Use

Assessing pain in advanced dementia is intuitively difficult; a validated scale can help.

When to Use

Patients with advanced dementia who may potentially be in pain. Particularly useful in aphasic patients or those who cannot otherwise report degree of pain.

Formula

Pearls / Pitfalls

The Pain Assessment in Advanced Dementia Scale (PAINAD) is a reliable assessment tool for dementia patients. It can be used in both nonverbal and verbal patients. While the tool results a continuous score between 0 and 10, there is no definitive evidence that it correlates with self-reported gradations of pain; the original study only defines 0 as “no pain” and 10 as “severe pain.” Caution should be used when titrating analgesic doses based on the score. Valid in varying levels of cognitive impairment from mild to severe. May also be useful in elderly patients who are reluctant to report pain, as it is more objective than self-reporting.

Critical Actions

Analgesic medications should be used judiciously in dementia, in a fashion guided by the patient’s (or proxy/surrogate’s) goals of care. Always keep the “double effect” of opioids in mind.

Advice

As with pain management in general, pain should be assessed serially and medications titrated accordingly. The PAINAD scale requires close and attentive observation of the patient.

More Information

Interpretation: Score Pain assessment 1-3 Mild pain 4-6 Moderate pain 7-10 Severe pain