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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    Pain Assessment in Advanced Dementia Scale (PAINAD)

    Assesses pain in patients with dementia.

    INSTRUCTIONS

    Choose the description that best fits the patient's behavior.
    When to Use
    Pearls/Pitfalls
    Why 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.

    • 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.

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

    Normal
    0
    Occasional labored breathing or short periods of hyperventilation
    +1
    Noisy labored breathing, long periods of hyperventilation or Cheyne-Stokes respirations
    +2
    None
    0
    Occasional moan/groan or low-level speech with negative quality
    +1
    Repeated troubled calling out, loud moaning/groaning/crying
    +2
    Smiling or inexpressive
    0
    Sad/frightened/frown
    +1
    Facial grimacing
    +2
    Relaxed
    0
    Tense, distressed pacing/fidgeting
    +1
    Rigid, fists clenched, knees pulled up, pulling/pushing away/striking out
    +2
    No need to console
    0
    Distracted or reassured by voice/touch
    +1
    Unable to console, distract or reassure
    +2

    Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights
    Ms. Victoria Warden, RN

    About the Creator

    Victoria Warden, RN, is a nursing research health scientist at the Geriatric Research Education Clinical Center at Edith Nourse Rogers Memorial Veterans Medical Center in Bedford, Massachusetts.

    To view Ms. Victoria Warden, RN's publications, visit PubMed

    Are you Ms. Victoria Warden, RN? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Randy Goldberg, MD, MPH, FACP
    About the Creator
    Ms. Victoria Warden, RN
    Are you Ms. Victoria Warden, RN?
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