title: The utility of PAINAD in assessing pain in a UK population with severe dementia.
abstract: OBJECTIVE
  Studies suggest that pain is under-recognized and under-treated in those with severe dementia. Identifying pain is the first step in its effective management. Few studies have investigated the utility of behavioural pain tools in those with advanced dementia.
  
  
  METHODS
  Participants were nursing home residents with advanced dementia who were observed on three occasions using a pain assessment tool (PAINAD). Following further assessment, an appropriate management plan was formulated for those thought to be in pain. Participants who scored above the cutoff (two) on the PAINAD scale, but were felt not to be in pain, formed the false positive group. The pain and false positive groups were reassessed at 1 and 3 months.
  
  
  RESULTS
  Seventy-nine participants completed the study, with 39 participants scoring above two on the PAINAD. Of these, only 13 were assessed as being in pain. The other 26 participants who scored above the cutoff on PAINAD were not felt to be in pain. Instead, their behaviour had a psychosocial explanation, often to do with a lack of understanding as to what was happening to them. The sensitivity of PAINAD was 92%. In those with pain, a significant decrease was demonstrated in the PAINAD scores on intervention following treatment for pain (p=0.008).
  
  
  CONCLUSIONS
  PAINAD is a sensitive tool for detecting pain in people with advanced dementia, but has a high false positive rate, frequently detecting psychosocial distress rather than pain. PAINAD can be used to assess whether pain management strategies have been successful.
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, UK. alicejordan74@hotmail.co.uk
authors.forename: Alice
authors.initials: A
authors.lastname: Jordan
authors.forename: Julian
authors.initials: J
authors.lastname: Hughes
authors.forename: Mani
authors.initials: M
authors.lastname: Pakresi
authors.forename: Sarah
authors.initials: S
authors.lastname: Hepburn
authors.forename: John T
authors.initials: JT
authors.lastname: O'Brien
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000150:complications* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis* / Q000517:prevention & control; D010147:Pain Measurement / Q000379:methods*; D012680:Sensitivity and Specificity; D006113:United Kingdom