PAIN ASSESSMENT IN THE COGNITIVELY IMPAIRED ( PAINAD )
ITEMS
0
1
2
SCORE
Breathing independent of vocalization
Noisy labored breathing. Long period of hyperventilation. Cheyne-Stokes respirations Repeated troubled, calling out. Loud moaning or groaning. Crying.
Occasional labored breathing. Short period of hyperventilation.
None
Occasional moaning or groaning. Low level speech with a negative or disapproving quality.
Negative vocalization
None
Sad. Frightened. Frowning.
Facial Expression Smiling /
Facial grimacing.
inexpressive
Rigid. Fists clenched. Knees pulled up. Pulling or pushing away. Striking out.
Tense. Distressed pacing. Fidgeting.
Body language
Relaxed
No need
Distracted or reassured by voice or touch.
Unable to console, distract or reassure.
Consolability
toconsole
TOTAL
9 NB: These Reference Cards do not replace careful clinical judgment specific to each patient / family situation. PCIC: Palliative Care Interdisciplinary Curriculum is a collaborative effort of OhioHealth, The Ohio State University Wexner Medical Center, and Nationwide Children’s Hospital in Columbus, Ohio, USA, and other contributors. Permission to reproduce any or all of these PCIC Reference Cards is granted for non-commercial educational purposes only, provided that the attribution statement and copyright are displayed. To reproduce for all other purposes, contact Frank D. Ferris at info@pallmed.us. Copyright © Frank D Ferris 2013-2024. All rights reserved. V14.1, 2024 The PAINAD was developed and tested by clinicians and researchers at the New England geriatric research Education and clinical center, a Department of Veterans Affairs center of excellence with divisions at EN Rogers Memorial Veterans hospital, Bedford, MA, and VA Boston health System. Used with permission. Warden V et al. J Am Med Dir Assoc. 2003. PMID 12807591
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