# PAINAD (Warden)

PAINAD

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/painad`
HTML: https://magentlab.com/docs/painad
Markdown: https://magentlab.com/docs/painad.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Sum five caller-assigned Warden 2003 PAINAD integers (0-2) and return the published total (max 10).

## When to use

When an agent has already assigned Warden 2003 0-2 integers for breathing, negative vocalization, facial expression, body language, and consolability and needs the published total, not a pain diagnosis, analgesic order, or later intensity cutoff.

## When not to use

- Not a medical device and not a pain diagnosis or analgesic order.
- Each of the five items is a caller-assigned integer 0, 1, or 2 from Warden 2003. magent does not observe the patient.
- Total is 0-10. magent does not add intensity cutoffs that are not in Warden 2003.

## Formula

```
PAINAD = breathing + negative_vocalization + facial_expression + body_language + consolability; each caller-assigned 0-2; max 10
```

## Citation

[Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale](https://doi.org/10.1097/01.JAM.0000043422.31640.F3)
Warden V, Hurley AC, Volicer L
J Am Med Dir Assoc. 2003;4(1):9-15
DOI: [10.1097/01.JAM.0000043422.31640.F3](https://doi.org/10.1097/01.JAM.0000043422.31640.F3)

## Worked example

### All items 0

Given: `body_language=0, breathing=0, consolability=0, facial_expression=0, negative_vocalization=0`

1. breathing 0 + negative_vocalization 0 + facial_expression 0 + body_language 0 + consolability 0
2. Score = 0 (max 10)


### All items 2

Given: `body_language=2, breathing=2, consolability=2, facial_expression=2, negative_vocalization=2`

1. breathing 2 + negative_vocalization 2 + facial_expression 2 + body_language 2 + consolability 2
2. Score = 10 (max 10)


## Also searched as

- PAINAD
- Pain Assessment in Advanced Dementia
- Warden PAINAD
- PAINAD scale
- dementia pain assessment
- Warden 2003 PAINAD

## Parameters

- `breathing` (integer, required): Caller-assigned Warden 2003 PAINAD breathing independent of vocalization (integer 0-2): 0 normal; 1 occasional labored breathing or short period of hyperventilation; 2 noisy labored breathing, long period of hyperventilation, or Cheyne-Stokes respirations. magent does not observe the patient.
- `negative_vocalization` (integer, required): Caller-assigned Warden 2003 PAINAD negative vocalization (integer 0-2): 0 none; 1 occasional moan or groan, or low-level speech with a negative or disapproving quality; 2 repeated troubled calling out, loud moaning or groaning, or crying. magent does not observe the patient.
- `facial_expression` (integer, required): Caller-assigned Warden 2003 PAINAD facial expression (integer 0-2): 0 smiling or inexpressive; 1 sad, frightened, or frown; 2 facial grimacing. magent does not observe the patient.
- `body_language` (integer, required): Caller-assigned Warden 2003 PAINAD body language (integer 0-2): 0 relaxed; 1 tense, distressed pacing, or fidgeting; 2 rigid, fists clenched, knees pulled up, pulling or pushing away, or striking out. magent does not observe the patient.
- `consolability` (integer, required): Caller-assigned Warden 2003 PAINAD consolability (integer 0-2): 0 no need to console; 1 distracted or reassured by voice or touch; 2 unable to console, distract, or reassure. magent does not observe the patient.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/painad`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "body_language": "0",
      "breathing": "0",
      "consolability": "0",
      "facial_expression": "0",
      "negative_vocalization": "0"
    },
    {
      "body_language": "0",
      "breathing": "0",
      "consolability": "0",
      "facial_expression": "0",
      "negative_vocalization": "0"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/painad

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/painad",
  "items": [
    {
      "components": [
        {
          "value": 0,
          "factor": "breathing",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "negative_vocalization",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "facial_expression",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "body_language",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "consolability",
          "points": 0,
          "present": true
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Warden V, Hurley AC, Volicer L",
        "doi": "10.1097/01.JAM.0000043422.31640.F3",
        "id": "warden-2003",
        "pmid": "12807591",
        "source": "J Am Med Dir Assoc. 2003;4(1):9-15",
        "title": "Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale"
      },
      "formula": "painad",
      "formula_expression": "PAINAD = breathing + negative_vocalization + facial_expression + body_language + consolability; each caller-assigned 0-2; max 10",
      "max_score": 10,
      "score": 0
    },
    {
      "components": [
        {
          "value": 0,
          "factor": "breathing",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "negative_vocalization",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "facial_expression",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "body_language",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "consolability",
          "points": 0,
          "present": true
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Warden V, Hurley AC, Volicer L",
        "doi": "10.1097/01.JAM.0000043422.31640.F3",
        "id": "warden-2003",
        "pmid": "12807591",
        "source": "J Am Med Dir Assoc. 2003;4(1):9-15",
        "title": "Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale"
      },
      "formula": "painad",
      "formula_expression": "PAINAD = breathing + negative_vocalization + facial_expression + body_language + consolability; each caller-assigned 0-2; max 10",
      "max_score": 10,
      "score": 0
    }
  ]
}
```

## Response fields

- `formula` (string): painad
- `formula_expression` (string): Exact expression used
- `score` (integer): PAINAD points 0-10
- `max_score` (integer): Always 10
- `components` (array): Per-item caller-assigned points
- `citation` (object): Warden et al. J Am Med Dir Assoc 2003 citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "components": [
    {
      "value": 0,
      "factor": "breathing",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "negative_vocalization",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "facial_expression",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "body_language",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "consolability",
      "points": 0,
      "present": true
    }
  ],
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Warden V, Hurley AC, Volicer L",
    "doi": "10.1097/01.JAM.0000043422.31640.F3",
    "id": "warden-2003",
    "pmid": "12807591",
    "source": "J Am Med Dir Assoc. 2003;4(1):9-15",
    "title": "Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale"
  },
  "formula": "painad",
  "formula_expression": "PAINAD = breathing + negative_vocalization + facial_expression + body_language + consolability; each caller-assigned 0-2; max 10",
  "max_score": 10,
  "score": 0
}
```

## Errors

- HTTP 400 `invalid_painad`: each PAINAD item must be an integer 0, 1, or 2 (Warden 2003). Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [Glasgow Coma Scale](https://magentlab.com/docs/gcs) — Compute the Glasgow Coma Scale as the sum of caller-assigned eye, verbal, and motor integers. The 1974 or 1976 edition is required.
- [4AT](https://magentlab.com/docs/4at) — Sum the Bellelli 2014 4AT items and return unlikely (0), possible cognitive impairment (1–3), or possible delirium (≥4).

## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.