This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
People with advanced dementia often cannot describe pain, and untreated pain can show up as agitation, refusal of care or withdrawal. The PAINAD scale (Pain Assessment in Advanced Dementia) was developed by Victoria Warden, Ann Hurley and Ladislav Volicer at a US veterans’ hospital and published in 2003. It is simple enough to be used by nurses and care staff in a few minutes.
The five items
| Item | 0 | 1 | 2 |
|---|---|---|---|
| Breathing, independent of vocalization | normal | occasional labored breathing, short hyperventilation | noisy labored breathing, long hyperventilation, Cheyne-Stokes |
| Negative vocalization | none | occasional moan or groan, low speech with a negative quality | repeated troubled calling out, loud moaning, crying |
| Facial expression | smiling or inexpressive | sad, frightened, frowning | grimacing |
| Body language | relaxed | tense, distressed pacing, fidgeting | rigid, fists clenched, knees pulled up, pulling away, striking out |
| Consolability | no need to console | distracted or reassured by voice or touch | unable to console, distract or reassure |
The total runs from 0 to 10.
Reading the score
- 0: no sign of pain.
- 1 to 3: mild pain.
- 4 to 6: moderate pain.
- 7 to 10: severe pain.
These bands are commonly used in practice, though the original authors did not validate exact thresholds. The trend over time, and the response to treatment, matter most.
How to assess
Watch the person for about five minutes, ideally both at rest and during an activity such as a transfer, washing or walking. Score what you see, then compare with earlier scores and with what family and staff know of the person’s usual behavior.
Example
A resident who breathes heavily at times (1), moans occasionally (1), frowns (1) and fidgets (1) but calms when spoken to (0) scores 4: moderate pain, worth checking for a cause and offering pain relief.
Limits
Distress, hunger, fear, delirium or a full bladder can produce the same behaviors as pain. A low score does not rule out pain in a person who withdraws. The scale helps decide when to look further and to treat; a trial of analgesia with reassessment is often part of the evaluation.