Dealing with pain

People with dementia can and do experience pain. However, they may not be able to communicate their pain clearly, or they may not be able to accurately interpret pain signals and will convey their discomfort through other behaviour. As a result the pain can often go unnoticed and untreated.

As far as we know, dementia itself does not actually cause pain. However, people with dementia will be affected by the same range of ailments as people without dementia, and some of these may be painful.

Research suggests that when a person has dementia and pain is present, they can be at risk of not being treated because of two misinformed beliefs - firstly, that a person with dementia does not experience pain, and secondly, that nothing can be done for people with dementia.

Causes of pain
It is important to be aware of potentially painful medical conditions. In older adults these include:-

• Osteoarthritis
• Osteoporosis
• History of hip and other types of fractures
• Back pain
• Cancer

Other causes of pain include:-
• Constipation
• Dental problems
• Infections
• Migraines or headaches
• Pressure sores

Recognising pain
Recognising that someone with dementia is in pain is not always easy. Pain is a highly personal experience, and assessment is usually based on our perception of the pain and reporting its type, severity and location. But for someone with dementia who has difficulty communicating, pain will need to be recognised in other ways. Some behaviours and symptoms may indicate that a person has some level of pain or discomfort, or is unwell.

These may include:-
• Changes in behaviour. The person may appear withdrawn, lethargic, frustrated or angry
• Sleeping more than usual
• Crying
• Facial or verbal expressions may indicate soreness of a particular part of the body
• Reluctance to move

Asking about pain
When asking a person with dementia about their health, try to use a range of words that might help the person describe their feelings. Words like discomfort, uncomfortable, hurting, aching or sore may be helpful. Ask at regular intervals, rather than just once.

Treating pain
All indicators of pain should be taken seriously. Always discuss your concerns with the doctor who will be able to check whether there is a physical illness or discomfort present, and provide some advice for managing any pain. If medication is prescribed to relieve pain it may be important that it is administered regularly, rather than just when signs of pain are present. Your doctor can advise you about this. There may be other things that you can do to reduce the pain. Consider whether a soothing bath or massage would help.

If the person is in residential care
It is possible for pain to sometimes go unrecognised and untreated in residential facilities. Talk to the doctor and nursing staff if you are concerned that a resident may be in pain. Your knowledge of the behavioural signs of pain is important to help staff recognise that pain is present. Make sure that staff are regularly assessing for pain and that it is being managed effectively. Good residential care practices aim to improve the management of pain in people with dementia.

People with dementia can, and should, have any pain treated quickly and effectively. Pain may dramatically affect their memory and confusion.

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Did you know?

The number of people with dementia is increasing rapidly. It is estimated that there are currently 1,400 people in Jersey living with dementia, many of whom have not as yet obtained a formal diagnosis; this number is set to double over the next 25 years.