Opi
Calc
AKPS — Australia-modified Karnofsky Performance Status
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
Recent Journal Updates
Diabetologia
Apr 15, 2026
Nature vs nurture of glucose homeostasis trajectories in children from the ALSPAC study
Why this matters
Broad domain relevance to PAINAD.
Diabetologia
Apr 13, 2026
Updates on paediatric MASLD: insights from an endocrine lens
Why this matters
Broad domain relevance to PAINAD.
Diabetologia
Mar 14, 2026
The glycaemic response to morning fasted resistance exercise is more consistent than the response to afternoon fed resistance exercise for adults with type 1 diabetes: a randomised crossover comparison
Why this matters
Broad domain relevance to PAINAD.
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
AKPS — Australia-modified Karnofsky Performance Status
BODE Index
CAM-S
CPOT
Death Rattle Scoring
Distress Thermometer
e-PaP Score
Edmonton Symptom Assessment System
FAST Scale
IPOS
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