Score each of the five behaviours from 0 to 2 based on the most representative observation, then sum for a total PAINAD score from 0 (no observed pain behaviours) to 10 (more observed pain-related behaviours). Higher scores indicate more observed pain-related behaviours, but PAINAD is not a precise pain-intensity scale.

Item	0	1	2
Breathing independent of vocalisation	Normal breathing	Occasional laboured breathing or short period of hyperventilation	Noisy laboured breathing, long period of hyperventilation, or Cheyne–Stokes respirations
Negative vocalisation	None	Occasional moan or groan, or low-level speech with a negative or disapproving quality	Repeated troubled calling out, loud moaning or groaning, or crying
Facial expression	Smiling or inexpressive	Sad, frightened, or frown	Facial grimacing
Body language	Relaxed	Tense, distressed pacing, or fidgeting	Rigid, fists clenched, knees pulled up, pulling or pushing away, or striking out
Consolability	No need to console	Distracted or reassured by voice or touch	Unable to console, distract, or reassure

The PAINAD score is the sum of all five item scores (range 0–10).

Pain Assessment in Advanced Dementia Scale (PAINAD)