What PAIC15 score could flag possible pain in dementia care?

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Observational pain scales can help identify pain in people with dementia who may struggle to express it verbally. The Pain Assessment in Impaired Cognition-15 (PAIC15) includes 15 signs of pain, with summed scores from 0 to 45, but the probability of pain at each score was unclear.

Researchers aimed to determine the sensitivity and specificity of PAIC15 cut-offs for probable pain against three standards: self-report when the person was able to provide it; the established cut-off of 2 on the Pain Assessment in Advanced Dementia (PAINAD); and an observer’s overall estimate based on a series of systematic observations.

They used data from 238 nursing home residents with dementia, observed by their physician in training or nursing staff as part of an evidence-based medicine (EBM) training study. Of these residents, 137 were reassessed after 2 months.

The area under the receiver operating characteristic (ROC) curve was excellent against the PAINAD cut-off (≥0.8), but acceptable or less than acceptable against the other two standards. Across the standards and criteria for optimal sensitivity and specificity, PAIC15 scores of 3 or higher represented possible pain for screening in practice. Against self-report, sensitivity and specificity were in the 0.5 to 0.7 range. The researchers noted that sensitivity may be too low for screening in practice, while a cut-off of 4 is reasonable to indicate probable pain in research.