The Pain Assessment in Advanced Dementia (PAINAD) scale measures pain in people who can no longer describe it reliably. Five behaviours are observed for about five minutes and scored from 0 to 2, giving a total from 0 to 10.
It was developed in 2003 at the US Veterans Affairs and is widely used in long-term care, palliative care and hospital wards.
Zdrovia: https://www.zdrovia.ca/resources/painad-scale/
Pain in Advanced Dementia
PAINAD Scale Calculator
Observe for five minutes and score breathing, vocalisation, facial expression, body language and consolability from 0 to 2 each, for a total out of 10.
Total score
0 of 5 items scored
Score every item to see the result
Item breakdown
These results are estimates based on published clinical data and are for informational purposes only. They do not constitute medical advice, a diagnosis, or a treatment recommendation. Consult a licensed aesthetic practitioner before beginning any treatment. Individual results vary.
Zdrovia's smart blocks drop validated scales into the visit note, keep every item score, and graph the total across visits so the trend is visible at a glance. See how smart blocks work →
PAINAD scoring
| Item | 0 | 1 | 2 |
|---|---|---|---|
| Breathing | Normal | Occasional laboured breathing | Noisy laboured breathing, Cheyne-Stokes |
| Negative vocalisation | None | Occasional moan or groan | Repeated calling out, loud moaning, crying |
| Facial expression | Smiling or inexpressive | Sad, frightened, frowning | Grimacing |
| Body language | Relaxed | Tense, pacing, fidgeting | Rigid, fists clenched, striking out |
| Consolability | No need to console | Distracted or reassured by voice or touch | Unable to console |
Total 0–10: 1–3 mild · 4–6 moderate · 7–10 severe pain.
Score it straight into the chart
Zdrovia's smart blocks drop validated scales into the visit note, keep every item score, and graph the total across visits so the trend is visible at a glance.
How to use PAINAD
Observe the person for five minutes, ideally during activity such as care or transfers, since pain often shows on movement. Score each item, add them up and reassess after an intervention. Comparing the person against their own usual behaviour, with input from staff or family who know them, makes the score more reliable.
Interpreting the score
Higher scores suggest more pain, but the behaviours PAINAD observes can also reflect distress, delirium, hunger or fatigue. A raised score is a prompt to look for a cause and try comfort measures or analgesia, then reassess.
Staging dementia: FAST dementia scale →
Other clinical assessment references