Opi
Calc
BODE Index (Palliative context)
CAM-S (Confusion Assessment Method - Severity)
CPOT (Critical-Care Pain Observation Tool)
Death Rattle Scoring (Victoria)
Distress Thermometer
Edmonton Symptom Assessment System (ESAS-r)
FAST Scale (Dementia)
IPOS (Integrated Palliative Outcome Scale)
Memorial Symptom Assessment Scale (MSAS)
Menten Score
Morphine Equivalent Daily Dose (MEDD)
Nursing Delirium Screening Scale (Nu-DESC)
Opioid Risk Tool (ORT)
PAINAD Scale
Palliative Performance Scale (PPSv2)
Palliative Prognostic (PaP) Score
Palliative Prognostic Index (PPI)
Respiratory Distress Observation Scale (RDOS)
Richmond Agitation-Sedation Scale (RASS-PAL)
Seattle Heart Failure Model (SHFM)
e-PaP Score
PAINAD Scale
PAINAD: Pain Assessment in Advanced Dementia (5-item observational tool for non-verbal patients).
Breathing (0-2)
0 - Normal breathing
1 - Occasional labored or rapid breathing
2 - Frequent labored or rapid breathing
Vocalization (0-2)
0 - No sounds
1 - Occasional moans, groans, whimpering
2 - Frequent loudness, crying, screaming
Facial Expression (0-2)
0 - Smiling or inexpressive
1 - Sad, worried, frowning, tense
2 - Grimacing, clenched teeth, closed eyes
Body Language (0-2)
0 - Relaxed posture
1 - Occasional restlessness/anxiety, muscle tension
2 - Rigid posture, clenched fists, rapid movements
Consolability (0-2)
0 - No distress behaviors observed
1 - Distress alleviated by voice/touch
2 - Unable to console, distract, or reassure
Calculate PAINAD Score
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Pain assessment in non-verbal patients with advanced dementia
Identification of pain in patients unable to self-report
Monitoring pain response to analgesic interventions
Guiding palliative management in dementia populations
Section 2
Formula & Logic
Scale Components
Breathing independent of vocalization
Negative vocalization
Facial expression
Body language
Consolability
Scoring
0 points per item
No pain behavior
1–2 points per item
Possible pain behavior
Maximum
10 points
Score ≥ 1
Consider analgesic trial
Section 3
Pearls/Pitfalls
Key Advantages
Specifically designed for advanced dementia populations
Brief observational assessment; no patient cooperation required
Validated and widely recommended in geriatric palliative care
Known Limitations
Observer-dependent; requires familiarity with patient baseline
Cannot distinguish pain from other causes of distress
Last Comprehensive Review: 2026
Related Palliative Care Tools
Palliative Prognostic Index
Palliative Prognostic
e-PaP Score
Menten Score
Edmonton Symptom Assessment System
IPOS
Distress Thermometer
Memorial Symptom Assessment Scale
Morphine Equivalent Daily Dose
Opioid Risk Tool
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