PAINAD — Pain Assessment in Advanced Dementia
Five-item observer-rated pain scale for non-verbal patients with advanced dementia (Warden 2003). Each item 0–2. Total 0–10. Use during 5-minute observation including movement.
Score interpretation
No behavioural signs of pain at this assessment.
→ Continue current analgesia plan. Reassess with movement, after procedures, and 4-hourly minimum in advanced dementia.
Mild pain or discomfort behaviours.
→ Look for reversible causes (constipation, urinary retention, position, pressure injury, infection); comfort measures; consider regular paracetamol; reassess after each intervention.
Moderate pain behaviours.
→ Address reversible cause (constipation, urinary retention, position, pressure injury, infection). Trial regular paracetamol; step up to weak opioid; rule out behavioural causes (delirium).
Severe pain behaviours.
→ Strong opioid PRN with regular review; non-pharmacological measures (positioning, music, presence). Specialist palliative-care input. Avoid using antipsychotics for what is actually pain — common error in dementia.
Interpretation bands for the PAINAD. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Methoxyflurane · Inhaled Analgesic — Acute Pain
- Donepezil · Acetylcholinesterase inhibitor (AChEI) — dementia
- Memantine · NMDA receptor antagonist — dementia
- Rivastigmine · Dual AChEI and BuChEI inhibitor — dementia
- Quetiapine (Elderly — Dementia Caution) · Atypical Antipsychotic
- Fentanyl Transdermal Patch (Elderly Chronic Pain) · Opioid Analgesic — Transdermal Patch
- Falls Assessment in Older Adults · NICE CG161 2013
- Delirium Outside ICU · NICE CG103
- Comprehensive Geriatric Assessment (CGA) · BGS / NICE
- Delirium Assessment and Management · NICE CG103 2010
- Frailty Recognition and Management · BGS Frailty Framework / NHS NHSE
- Polypharmacy and Medicines Optimisation · STOPP/START v2 2014 / NICE NG5
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.