**P**ain **A**ssessment **IN** **A**dvanced **D**ementia

**PAINAD**

**Item definitions**

**Breathing**

1\. [Normal breathing]{.underline}. DESCRIPTION: Normal breathing is
characterized by effortless, quiet, rhythmic (smooth) respirations.

2\. [Occasional labored breathing]{.underline}. DESCRIPTION: Occasional
labored breathing is characterized by episodic bursts of harsh,
difficult or wearing respirations.

3\. [Short period of hyperventilation]{.underline}. DESCRIPTION: Short
period of hyperventilation is characterized by intervals of rapid, deep
breaths lasting a short period of time.

4\. [Noisy labored breathing]{.underline}. DESCRIPTION: Noisy labored
breathing is characterized by negative sounding respirations on
inspiration or expiration. They may be loud, gurgling, wheezing. They
appear strenuous or wearing.

5\. [Long period of hyperventilation]{.underline}. DESCRIPTION: Long
period of hyperventilation is characterized by an excessive rate and
depth of respirations lasting a considerable time.

6\. [Cheyne-Stokes respirations]{.underline}. DESCRIPTION: Cheyne-
Stokes respirations are characterized by rhythmic waxing and waning of
breathing from very deep to shallow respirations with periods of apnea
(cessation of breathing).

**Negative Vocalization**

1[. None]{.underline}. DESCRIPTION: None is characterized by speech or
vocalization that has a neutral or pleasant quality.

2\. [Occasional moan or groan]{.underline}. DESCRIPTION: Occasional
moaning is characterized by mournful or murmuring sounds, wails or
laments. Groaning is characterized by louder than usual inarticulate
involuntary sounds, often abruptly beginning and ending.

3\. [Low level speech with a negative or disapproving
quality]{.underline}. DESCRIPTION: Low level speech with a negative or
disapproving quality is characterized by muttering, mumbling, whining,
grumbling, or swearing in a low volume with a complaining, sarcastic or
caustic tone.

4\. [Repeated troubled calling out]{.underline}. DESCRIPTION: Repeated
troubled calling out is characterized by phrases or words being used
over and over in a tone that suggests anxiety, uneasiness, or distress.

5\. [Loud moaning or groaning]{.underline}. DESCRIPTION: Loud moaning is
characterized by mournful or murmuring sounds, wails or laments in much
louder than usual volume. Loud groaning is characterized by louder than
usual inarticulate involuntary sounds, often abruptly beginning and
ending.

6\. [Crying]{.underline}. DESCRIPTION: Crying is characterized by an
utterance of emotion accompanied by tears. There may be sobbing or quiet
weeping.

**Facial Expression**

1\. [Smiling or inexpressive]{.underline}. DESCRIPTION: Smiling is
characterized by upturned corners of the mouth, brightening of the eyes
and a look of pleasure or contentment. Inexpressive refers to a neutral,
at ease, relaxed, or blank look.

2\. [Sad]{.underline}. DESCRIPTION: Sad is characterized by an unhappy,
lonesome, sorrowful, or dejected look. There may be tears in the eyes.

3\. [Frightened]{.underline}. DESCRIPTION: Frightened is characterized
by a look of fear, alarm or heightened anxiety. Eyes appear wide open.

4\. [Frown]{.underline}. DESCRIPTION: Frown is characterized by a
downward turn of the corners of the mouth. Increased facial wrinkling in
the forehead and around the mouth may appear.

5\. [Facial grimacing]{.underline}. DESCRIPTION: Facial grimacing is
characterized by a distorted, distressed look. The brow is more wrinkled
as is the area around the mouth. Eyes may be squeezed shut.

**Body Language**

1\. [Relaxed]{.underline}. DESCRIPTION: Relaxed is characterized by a
calm, restful, mellow appearance. The person seems to be taking it easy.

2\. [Tense]{.underline}. DESCRIPTION: Tense is characterized by a
strained, apprehensive or worried appearance. The jaw may be clenched.
(exclude any contractures)

3\. [Distressed pacing]{.underline}. DESCRIPTION: Distressed pacing is
characterized by activity that seems unsettled. There may be a fearful,
worried, or disturbed element present. The rate may by faster or slower.

4\. [Fidgeting]{.underline}. DESCRIPTION: Fidgeting is characterized by
restless movement. Squirming about or wiggling in the chair may occur.
The person might be hitching a chair across the room. Repetitive
touching, tugging or rubbing body parts can also be observed.

5\. [Rigid]{.underline}. DESCRIPTION: Rigid is characterized by
stiffening of the body. The arms and/or legs are tight and inflexible.
The trunk may appear straight and unyielding. (exclude any contractures)

6\. [Fists clenched]{.underline}. DESCRIPTION: Fists clenched is
characterized by tightly closed hands. They may be opened and closed
repeatedly or held tightly shut.

7\. [Knees pulled up]{.underline}. DESCRIPTION: Knees pulled up is
characterized by flexing the legs and drawing the knees up toward the
chest. An overall troubled appearance. (exclude any contractures)

8\. [Pulling or pushing away]{.underline}. DESCRIPTION: Pulling or
pushing away is characterized by resistiveness upon approach or to care.
The person is trying to escape by yanking or wrenching him or herself
free or shoving you away.

9\. [Striking out]{.underline}. DESCRIPTION: Striking out is
characterized by hitting, kicking, grabbing, punching, biting, or other
form of personal assault.

**Consolability**

1\. [No need to console]{.underline}. DESCRIPTION: No need to console is
characterized by a sense of well being. The person appears content.

2\. [Distracted or reassured by voice or touch]{.underline}.
DESCRIPTION: Distracted or reassured by voice or touch is characterized
by a disruption in the behavior when the person is spoken to or touched.
The behavior stops during the period of interaction with no indication
that the person is at all distressed.

3\. [Unable to console, distract or reassure]{.underline}. DESCRIPTION:
Unable to console, distract or reassure is characterized by the
inability to sooth the person or stop a behavior with words or actions.
No amount of comforting, verbal or physical, will alleviate the
behavior.