In dementia-affected seniors, pain management is critical. Pain has a tremendous influence on physiological, spiritual, social, and physical factors. As a result, pain affects not just the quality of life of people living with dementia but also their caregivers and healthcare providers. In addition, untreated pain has evident side effects.
The link between dementia and pain neurophysiology, however, is largely unexplored. Changes in attitude and behavior, inexplicable suffering, anger, sadness, isolation, falls, starvation, and a significant chance of faulty treatment and associated adverse effects can all occur if the pain is left untreated or inadequately treated. As a result, pain management is crucial.
Untreated pain in dementia-affected older persons can be due to various factors.
An inability to articulate one’s own suffering is a significant factor. Dementia has a significant impact on communication, resulting in stuttering, which leads to inaccurate assessment and pain identification and management.
Dementia patients may find it more difficult to convey their discomfort to their caregivers, resulting in a lower quality of life.
Looking for non-verbal signals of discomfort and offering appropriate treatment can help to prevent this. This article discusses assessing and managing pain in people living with dementia.
Is There a Difference in The Way Dementia Patients Perceive Pain?
Alzheimer’s disease and other kinds of dementia do not cause pain. People with dementia, however, are more likely to experience discomfort as a result of other factors, including falls, injuries, and accidents. In addition, older people, particularly those with dementia, are more prone to develop a variety of medical illnesses that cause pain.
It was previously considered that people living with dementia don’t experience pain because the damage to their brain prevents them from feeling it. However, this has been proven incorrect through research.
Patients with Alzheimer’s disease exhibited pain-related activity in the brain in the same brain regions as people without Alzheimer’s disease, according to a Melbourne research utilizing functional MRI. The researchers concluded that persons with dementia experience pain in the same manner that people without dementia do; they simply have difficulty communicating it to others. (1)
Dementia is characterized by a progressive loss of a person’s ability to comprehend and communicate with people around them. For example, the capacity to recognize and describe pain may be unaffected in the initial stages of the condition, but it is likely to deteriorate as the illness progresses. This might result in an unpleasant situation when a person with dementia is in agony and not receiving enough pain relief.
According to research, people with dementia, particularly those in assisted living, report less pain and take fewer pain relievers. However, we now realize that this is due to their inability to convey their degree of suffering and need for pain medication, not because they are in less pain. It is thus up to the caregivers to take extra precautions to determine whether the individual is in pain and adopt pain-relieving remedies.
Is it Possible for Dementia Patients to Communicate their Pain Verbally?
People with dementia could still detect if they’re in pain in the early stages. However, when their cognitive capacities deteriorate, they may be less able to comprehend why they are in pain and how to go about it.
Their declining brain function and communication skills may make it difficult for them to appropriately describe the location, intensity, and type of pain they are experiencing or remember to take pain relievers regularly, leaving them in discomfort.
Seniors may be less likely to report pain for various reasons other than dementia. Depression, fear of having surgery, hospitalization, or placement in a residential facility, a misunderstanding that all medicines are addictive, and a desire not to look weak or complain are all factors that might cause people to under-report their pain.
Pain reporting can be influenced by cultural, religious, and gender disparities. Some individuals may not want to impair their social standing by admitting they are in pain and need assistance or believe suffering should be endured in silence. In contrast, others think pain should be reported immediately and treated soon. Some men may think they need to be tough and hide their grief because of societal and cultural expectations.
To evaluate whether a person is at risk of under-reporting pain, examine their past, surroundings, and stage of dementia. Even if people with dementia appear to be able to speak normally, pain assessment strategies may need to go beyond just asking whether they’re in pain.
What Causes Pain in People Living With Dementia?
Pain can come from a variety of sources for people with dementia. For older individuals, the following are common causes of pain:
- Urinary tract infections
- Constipation
- Diabetes
- Bedsores
- Headache/Migraine
- Osteoporosis
- Arthritis
- Backache
- Undiagnosed or untreated injuries
- Toothache
- Infections
A comprehensive examination may be necessary to determine what’s causing the pain, especially if the individual has impaired communication skills.
What if The Pain is Left Untreated?
If a person with dementia’s pain remains unnoticed and untreated, they risk suffering unnecessarily and being prescribed incorrect remedies for their altered behavior. For example, if a person withdraws or gets upset due to pain, they may be diagnosed with depression and prescribed antidepressants.
Chronic pain can depress a person, but addressing the underlying issue adequately should alleviate both the pain and the melancholy. Antipsychotics may be administered if a person becomes violent or agitated due to pain. Antipsychotic drugs can have substantial negative effects. Again, addressing the underlying pain should minimize the harmful behaviors that occur.
Chronic pain might make it difficult to move around. This will make daily activities more difficult and increase the danger of falls and severe injuries. In addition, persistent pain may wreak havoc on brain function and thinking, exacerbating dementia symptoms and hastening degeneration.
Failure to recognize and manage pain in dementia patients has serious repercussions on their quality of life and can result in poor medical consequences.
What are The Non-Verbal Cues of Pain?
Many people with dementia lose their capacity to vocally communicate discomfort to others as the disease progresses. However, we can still tell if someone is in pain in this scenario by looking at nonverbal cues. In fact, in all phases of dementia, non-verbal cues can be useful in gauging pain. These indicators can be clearly pain-related, but they could also just be a deviation from normal behavior.
They may include the following:
- Facial wincing
- Distressing gestures
- Reluctance to move or defend a specific body area
- Groaning with movement
- Inadequate range of motion or sluggish movement
- Elevated heart rate, blood pressure, or sweating
- Interrupted or restless sleep
- Reduced appetite
- Withdrawn social behavior
- Aggressiveness
- Frustration
Of course, any of the above symptoms or changes might be caused by something else, but the pain must always be evaluated as a possible and treatable reason. It’s also vital to remember that some individuals will exhibit little or no distinctive pain-related behavior.
How to Assess Pain?
There is no straightforward way to assess a person’s pain like there is for pulse rate or eyesight. So instead, the most reliable measure of pain is a person’s self-report.
Individuals can be asked to fill out a questionnaire where they can rate their pain on a scale ranging from zero to ten. Zero being no pain at all and ten being the very sharp pain they have ever had. In addition, people could be asked to describe the type of pain they are experiencing, such as if it is acute or dull.
People with dementia, however, may have difficulty comprehending these questions and/or offering a response that truly portrays their pain, as we have learned.
Health providers may utilize official pain assessment measures to explore possible pain in people living with dementia. However, caregivers typically lack the skills and time necessary to recognize, diagnose, and manage pain in dementia patients. Learning to recognize indicators of pain in their loved ones and communicating their issues to health experts and care workers, friends, and family members can make a significant impact.
How to Manage Pain?
Once a person with dementia is diagnosed with pain, they should consult a doctor to establish the best course of action.
One can treat pain with a wide variety of medicines with the help of non-steroidal anti-inflammatory medications like ibuprofen, painkillers like aspirin or paracetamol, and opioids (like morphine and codeine). Always discuss with healthcare provider before giving/taking any medications.
The type of painkiller prescribed is determined by several factors, including the type and degree of pain, the expected duration of treatment, and the patient’s existing health conditions and medicines.
Seniors require extra caution since they could be more sensitive to some drugs and require a lower dose. People could also be more vulnerable to negative side effects and drug interactions. Check with your doctor or pharmacist to be sure you’ve got that covered and that your drug interaction is being thoroughly monitored.
Non-drug therapy can be used alone or in tandem with medications to relieve pain. Massage, use of heat or cold packs, mild exercise and stretching, physiotherapy, acupressure, and relaxation are some options.
Chronic pain, in particular, necessitates the inclusion of continuing pain treatment into the dementia patient’s care plan. The pain must be checked regularly, and therapy should be customized to their needs. Therapies should be altered as needed. And to successfully treat chronic pain, analgesics should be given regularly instead of only when they are needed.
Can we Prevent the Pain?
When caring for someone living with dementia, it’s important to take reasonable steps to avoid painful conditions, including infections, fractures, and bedsores. In addition, chronic disease may necessitate the use of medicines on a regular basis to treat persistent pain.
Summary
Due to the obstacles that gradual cognitive and functional decline provide, communication between patients and caregivers concerning pain is made more difficult while caring for persons with dementia.
Many symptoms are experienced by individuals who have severe dementia and are reaching the end of their lives. Because of their cognitive impairment, this patient population generally underreports pain. However, health care practitioners must be prepared for this difficulty and, where feasible, screen for and manage potential pain.
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