Pain and Dementia – Diagnostic and Treatment Challenges

Man Pain CroppedHaving others truly understand the depth or severity of our physical pain can be a challenging endeavor. How much more so for those with dementia, who may also experience confusion, memory loss or lack of ability to communicate clearly? In this delicate population, pain—especially chronic pain—may continue without diagnosis or proper treatment.

The National Institutes of Health estimates there are 35 million people with dementia worldwide, including 5 percent of those over 65. That escalates to more than 50 percent of those over 90.

As chronic pain rates also rise along with age, our ever-older population is likely to endure both pain and dementia—as well as the inability to express their discomfort. But there’s more to the story; there’s conflicting research on the way dementia neuropathology impacts pain processing and perception, too.

As chronic pain rates also rise along with age, our ever-older population is likely to endure both pain and dementia—as well as the inability to express it. 

Barriers to proper treatment abound. According to a 2014 article in Nursing Times, barriers may include lack of recognition by nursing staff and other caregivers; misdiagnosis; use of drugs that mask pain symptoms; poor guidelines and assessment tools; provider concerns about the use of pain relief medications; and other factors.

Not treating pain, however, can lead to decreased functional ability; a worsening of memory; delayed recovery from surgeries; and disruption in sleep, according to North West Dementia Centre. The U.K.-based organization recommends the following observational cues that may indicate pain with a dementia patient:

  • Behavioral changes (i.e., restlessness, anger, and wandering)
  • Mood changes (i.e., depression and withdrawal)
  • Facial expressions (i.e., frowning, sadness, and grimacing)
  • Body language (i.e., guarding, bracing, and rubbing)
  • Speech changes (i.e., shouting, groaning, and screaming)
  • Physical signs (i.e., pressure sores, skin tears, sweating, and loss of appetite)

Proper treatment, then, requires thorough assessment; acknowledgment of pain; the offer of comfort through massage, heat or ice packs, and the appropriate use of painkillers.

 

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