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 Ways Caregivers Can Judge Pain in Someone Who is Not Speaking
If you are caring for someone who is not speaking, it is still possible to get an idea of whether they are in pain and if so, how much. Use the questions below and rate how they are doing in each of the five areas.
Instructions: Observe the patient for five minutes before scoring his or her behaviors. Score the behaviors according to the following chart. Definitions of each item are provided on the following page. The patient can be observed under different conditions (e.g., at rest, during a pleasant activity, during caregiving, after the administration of pain medication).
Breathing Independent of Vocalization
Negative vocalization
Facial Expression
Body Language Consolability
2 Score
Occasional Labored Breathing Short period of Hyperventilation
Noisy Labored Breathing, Long Period of Hyperventilation, Cheyne- Stokes respirations
None or Usual Sound
Whimpering or moaning
Crying out, Screaming, Loud Moaning
Relaxed Calm and/or Smiling
Sad, Tense, Frowning
Wincing or Grimacing
Relaxed, Normal
Tense, Guarded
Fetal Position, Jumps at Touch, Striking out
    No need to Console
Distracted or reassured by Voice or Touch
Unable to console, distract, or reassure
The total score ranges from 0-10 points. A possible interpretation of the scores is: 1-3=mild pain; 4-6=moderate pain; 7-10=severe pain. These ranges are based on a standard 0-10 scale of pain, but have not been substantiated in the literature for this tool.
Source: Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia
(PAINAD) scale. J Am Med Dir Assoc. 2003;4(1):9-15. (Warden et al., 2003)

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