When someone cannot tell you they are in pain, you have to read it off their behaviour. PAINAD is the most widely used tool for doing that in advanced dementia: five behaviours, each 0 to 2, totalling 0 to 10. It is short enough to be used repeatedly and specific enough to be trainable, which is why it turns up in nursing-home and palliative protocols across the US, the UK and Australia.
Why it belongs in a video library. PAINAD is rated over an observation window, not a moment — the tool asks you to observe the person both at rest and during activity or movement. A recording is the ideal medium for that: you can rate the same window twice, compare raters on identical footage, and show the segment behind a score. Tag the interval you observed rather than the whole file.
Two items you can partly hear. Negative vocalization (moaning, crying, troubled calling out) and noisy laboured breathing are audible as well as visible, so they carry over usefully to audio-only recordings. Facial expression, body language and consolability need the picture.
Consolability is about the response to an attempt. You cannot rate it from footage in which nobody tries to console the person. If no consoling attempt occurs in your window, say so in the rationale rather than defaulting to 0 — an untested item scored 0 quietly deflates the total.
A caution about totals. The authors note the score reflects presence of pain-related behaviour, and there is still no agreed rule for turning a number into a treatment decision. Severity bands circulating online are not part of the published tool. Report the total, keep the item scores, and define your own thresholds in your protocol if you need them.