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    Patent Pending

    Pain Assessment in Advanced Dementia Scale (PAINAD)

    Assesses pain in patients with dementia.
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    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:

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    Next Steps
    Evidence
    Creator Insights

    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.

    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.

    Content Contributors
    • Randy Goldberg, MD, MPH, FACP
    About the Creator
    Ms. Victoria Warden, RN
    Are you Ms. Victoria Warden, RN?
    Partner Content
    Content Contributors
    • Randy Goldberg, MD, MPH, FACP