Experts estimate that at least 50% of people living withdementiaexperience daily pain, and research suggests that in those who have chronic pain, cognitive decline is likely to progress more quickly.
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Causes of Pain
There are two ways that dementia can cause or worsen pain:
In the latter case, the pain can stem from a separate health condition that may go un- or undertreated. These conditions most often includeosteoarthritis, urinary tract infections, falls, and pressure sores, all of which can cause significant pain.
Some research suggests that people with dementia may experience pain differently than those whose cognition is intact, while other experts argue that increased pain stems primarily from a reduced capability to express that pain. In either case, researchers tend to agree that people with dementia have a high risk of being under-treated for pain.
Ask the Person
In the general population, the accepted standard for rating pain is to simply ask the person about their pain. This is more complicated in people with dementia due to the gradual impairment of cognition andword-finding ability.
However, it has been demonstrated that in the early and even in themiddle stagesof dementia, many people are still able to accurately identify and express their pain; thus, they should be asked about it. In the later stages of dementia, it becomes more difficult for the person to express their pain.
Use Pain Scales
Asking a person with some confusion to rate their pain on a scale of one through 10 is not a good practice. Confusion may stem from the number of choices and relative interpretations of what each number could correlate to.
A more appropriate assessment tool for pain is the face scale, where the person points to the face that best represents how they feel about their pain. The faces range from very happy to very sad and crying.
Another simple way is to ask how much pain they have: a little, a little more, or a lot.
Pain Scales: Types of Scales and Using Them to Explain Pain
Ask a Loved One
Because dementia affects the ability to communicate, it can be very helpful to ask someone who knows the person with dementia about their pain. Consider asking these questions:
Other Signs of Pain
Be aware that the following challenging behaviors can all be signs of pain:
Challenges in Pain Management
The primary challenge in managing pain in people with dementia stems from the inability of the person to describe what they’re feeling. Based on just behaviors and reactions alone, it can be difficult to tell the difference between a source of physical pain, such as pain related to a condition, hunger, or needing to use the bathroom, versus an emotional pain, such as loneliness or boredom.
Another challenge for pain management in this population stems from caregivers' inability to properly assess or treat the pain, which could lead to a misdiagnosis. A person could be diagnosed as being anxious or depressed and prescribed psychotropic medications—which ultimately cannot help if the suffering is not due to an underlying mental health condition.
Alternative Approaches to Pain
Medicating for Pain Control
While non-drug approaches are important, many people will still benefit from prescribed pain medications. If you’ve ruled out other causes of behaviors (such as hunger, boredom, and the need for exercise), and you’ve determined that the person is likely experiencing pain, getting a prescription for pain medicine is a good idea.
Be wary of pain medications that are ordered on a PRN (as needed) basis. Because the person with dementia might not be able to express their pain well, or might not be aware of a gradual increase in discomfort until they’re in a lot of pain, PRN pain medications are more likely to result in poorly controlled pain.
Although family members may express the worry of possible addiction to pain medications, this is usually not a primary concern since drug-seeking behavior is not common in people with dementia. Additionally, many value quality of life, which is likely to improve with adequate pain control.
4 Sources
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Achterberg W, Lautenbacher S, Husebo B, et al.Pain in dementia.Pain Rep. 2019;5(1):e803. Published 2019 Dec 25. doi:10.1097/PR9.0000000000000803.Jones J, Sim TF, Hughes J.Pain assessment of elderly patients with cognitive impairment in the emergency department: Implications for pain management-A narrative review of current practices.Pharmacy (Basel). 2017;5(2). doi:10.3390/pharmacy5020030Paulson CM, Monroe T, Mion LC.Pain assessment in hospitalized older adults with dementia and delirium.J Gerontol Nurs. 2014;40(6):10-15. doi:10.3928/00989134-20140428-02Achterberg WP, Pieper MJ, van Dalen-Kok AH, et al.Pain management in patients with dementia.Clin Interv Aging. 2013;8:1471-1482. doi:10.2147/CIA.S36739
Achterberg W, Lautenbacher S, Husebo B, et al.Pain in dementia.Pain Rep. 2019;5(1):e803. Published 2019 Dec 25. doi:10.1097/PR9.0000000000000803.
Jones J, Sim TF, Hughes J.Pain assessment of elderly patients with cognitive impairment in the emergency department: Implications for pain management-A narrative review of current practices.Pharmacy (Basel). 2017;5(2). doi:10.3390/pharmacy5020030
Paulson CM, Monroe T, Mion LC.Pain assessment in hospitalized older adults with dementia and delirium.J Gerontol Nurs. 2014;40(6):10-15. doi:10.3928/00989134-20140428-02
Achterberg WP, Pieper MJ, van Dalen-Kok AH, et al.Pain management in patients with dementia.Clin Interv Aging. 2013;8:1471-1482. doi:10.2147/CIA.S36739
Achterberg WP, Pieper MJ, Van dalen-kok AH, et al.Pain management in patients with dementia.Clin Interv Aging.2013;8:1471-82. doi:10.2147/CIA.S36739
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