What does the PAINAD score measure and how is it scored?

The PAINAD (Pain Assessment in Advanced Dementia) scale measures pain in people with advanced dementia by scoring observable behaviours: breathing independent of vocalization, negative vocalization, facial expressions, body language, and consolability. Each of the five behaviours is rated 0, 1, or 2, giving a total score from 0 to 10. Scores of 1–3 indicate mild pain, 4–6 moderate pain, and 7–10 severe pain.

PAINAD was designed to assess pain in individuals who cannot self-report, specifically those with advanced dementia. A nurse observes the person and scores five behavioural domains: breathing pattern independent of vocalization, negative vocalization (such as moaning or crying), facial expressions, body language (for example tense, rigid, or striking out), and consolability. Each domain has three descriptor levels scored 0, 1, or 2. The maximum total is 10. The scale provides guidance for interpreting the total: 1 to 3 suggests mild pain, 4 to 6 moderate pain, and 7 to 10 severe pain, which can help guide analgesic decisions.