Original StudyWhich Score Most Likely Represents Pain on the Observational PAINAD Pain Scale for Patients with Dementia?
Section snippets
Strategies and Data Sources
We used 3 strategies to determine a cutoff score for the presence of pain on the PAINAD: (1) we related PAINAD observations to self-reported and proxy-reported pain, (2) we compared PAINAD scores between painful and supposedly less painful conditions, and (3) we related PAINAD scores to other observational pain scales with established cutoff scores for pain. These 3 strategies were applied to three data sources. The first data source was published reports, reviewing the literature on PAINAD,
Source 1: Cumulative Data From the Literature
The literature search revealed 2 studies that related PAINAD scores to a patient’s self-report17 and/or nurses’ report.17, 22 In the study by Leong and colleagues,17 nurses and 88 nursing home patients estimated PAINAD scores over 1 week. Based on self-report, mean PAINAD scores for patients who reported “no pain” was 1.0 (SD 1.4) versus 1.4 to 3.7 for patients reporting pain (Table 2). Not surprisingly, nurses’ proxy reports were more discriminative, with a mean of 0.1 for “no pain” and mean
Discussion
With the use of 3 strategies and based on 3 sources, a cutoff score between 1 and 2 on the PAINAD most likely represents pain in patients with dementia. A score above 2 probably represents pain in almost all patients and is most likely the cutoff value with optimal sensitivity and specificity.
Some limitations regarding this study must be considered. First, sample sizes of selected patients were small (data sources 2 [n = 75] and 3 [n = 30]) and consisted of mainly mildly and moderately demented
Conclusion
Although the majority of patients scoring 0 or 1 are not in pain, an important minority of patients are in pain, which implies that with low PAINAD scores, pain cannot be ruled out. This concurs with the literature, showing a tendency to underestimate pain in nonverbal patients,25 which may even extend the use of pain scales such as the PAINAD if implicitly relatively high cutoff scores are being used. Our findings concur with how the PAINAD is still in use in the nursing home where it was
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The authors have declared no conflicts of interest.