Pain Management in Patients or Loved Ones with Dementia
Pain is common is older adults, whether or not they have dementia. However, advanced dementia or Alzheimer’s disease presents additional challenges for pain management. It is a myth that people with dementia feel less pain. It just may be more difficult for them to communicate “where it hurts.” Or a person with dementia may not volunteer information about their pain as often as persons without cognitive impairment. Sometimes, what may be viewed as “acting out” can be attributed to undiagnosed pain.
The Alzheimer’s Association brochure, available from them and from DTN Home Care, provides the following considerations:
- Many people with dementia may not volunteer information about pain, but, when asked, they can often verbalize the experience, particularly when the affected area is moved or examined.
- People with dementia often have trouble expressing pain making it difficult to assess pain and discuss approaches to treatment.
- People with dementia communicate pain in different ways — verbally and non-verbally. As verbal ability declines, people with dementia rely more on non-verbal communication. This can include behavioral symptoms and resistance to care. These symptoms can lead to the inappropriate use of psychotropic medications.
A “vital sign”
Pain should be considered a “fifth vital sign” and assessed regularly, just like blood pressure, oxygen level and temperature. Even though assessment may be difficult, as care givers, we should be persistent in ensuring medical personal have correctly determined that our patient or loved one is not in pain. Pain relief methods and medications will be different for each person, and should be carefully and frequently monitored, as well.
Non-verbal cues to pain
If the person you are caring for cannot answer questions about pain, non-verbal cues that the person is in pain can be an important form of communication. Facial grimaces, moaning, resisting touch, favoring or frequently touching a body part, slow movement or other behavioral symptoms such as restlessness all can tell care givers that pain might be a factor that needs attention.
Every member of a patient’s home care team needs to help identify pain, and when applicable, report the pain to a qualified professional who can assist in managing that pain. Pain can be exhausting and frustrating to any of us. We can all relate to how decreasing discomfort can improve our ability to function, our mood, our appetite, our sleep and our overall quality of life.
You might be interested in this personal story by a care giver professional who had trouble getting her elderly father’s pain diagnosed. Dementia and pain management: a personal story, by Donna Schempp, Family Caregiver Alliance Program Director.
Medication and other pain relievers
Medication is sometimes necessary, but it doesn’t have to be the only answer. The person’s position, the heat or cold on the affected area, aromatherapy, music and other forms of relaxation or distraction can help to at least alleviate some forms of chronic pain. Care givers should always ask a Dr. or pharmacist about the possible side-effects of prescription or over-the-counter pain medication, which can be different in the elderly. Some medications my cause an increase in forgetfulness or sleepiness. Usually, you don’t need to worry about addiction when administering prescription pain medication. Someone with severe dementia isn’t likely to get hooked on pain meds. Receiving them can ease many behavioral symptoms (like poor sleep or aggression) that are exacerbated by pain. Be careful about ibuprofen, which can be especially hard on an older adult’s kidneys.
Prevention of pain is the first defense against it. Every member of the care giving team can help promote patient comfort and prevent painful conditions, such as bone fractures, pressure ulcers and skin tears, by being careful when providing care. Avoid having the person with dementia stay in one position too long or move too quickly. Be sure that activities are appropriate for the person’s abilities. (See our previous blog on Meaningful Activities & Interaction with Alzheimer’s Patients or Loved Ones.) In a future blog, we will discuss ways to prevent falls, which are a common cause of injury and pain in the elderly.