• Sandra M G Zwakhalen, Jenny T van der Steen, and M D Najim.
• Maastricht University, School for Public Health and Primary Care (Caphri), Maastricht, the Netherlands. S.Zwakhalen@maastrichtuniversity.nl
• J Am Med Dir Assoc. 2012 May 1; 13 (4): 384-9.

ObjectivesWe sought to determine a cutoff score for the observational Pain Assessment in Advanced Dementia (PAINAD), to adequately assess pain in clinical nursing home practice and research.Design And SettingWe used data from multiple sources. We performed a literature review on PAINAD, performed secondary data analysis of a study examining psychometric properties of PAINAD in nursing home patients with dementia, and performed another study in nursing home patients with dementia specifically aimed at determining a cutoff score for PAINAD.ParticipantsPatients with dementia in long term care facilities.MeasurementsWe related PAINAD scores (range 0 to 10) to (1) self-reported and proxy-reported pain by global clinical judgment and (2) scores on another pain assessment instrument (DOLOPLUS-2), and (3) we compared scores between painful and supposedly less painful conditions.ResultsFindings from this study showed that a cutoff value of 2 should serve as a trigger for a trial with pain treatment. Although the majority of patients scoring 1 or 0 were not in pain, pain could be ruled out.ConclusionBased on the findings of multiple available data sources, we recommend that a PAINAD score of 2 or more can be used as an indicator of probable pain. A score of 1 is a sign to be attentive to possible pain. Future work may focus on cutoff scores for the presence of pain and severe pain in other frequently used pain tools, and on further development of methodology to assess cutoff scores.Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

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