Best Tips For Managing Pain In Dementia

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People living with a diagnosis of dementia don’t feel pain as much as the rest of us. Right? Unfortunately, many people still believe this myth.

While it may appear to be true, this is because the resident loses the ability to communicate the pain they’re feeling. They also forget how to ask for help when they’re in pain.

It’s so important for us to remember that someone with dementia can experience a toothache, arthritic pain, a headache, or any other pain just like the rest of us.

When someone is living with dementia, we might see changes in their behavior, such as restlessness, decreased appetite, withdrawal, or aggression. Too often, we assume these changes result from the dementia diagnosis itself. We forget it could be a normal response to pain. (I know I sometimes get crabby when I’m in pain. How about you?)

It’s also important to ask ourselves if something else besides pain could cause discomfort. For example, is the resident thirsty, constipated, too hot/cold, or tired?

How To Assess Pain

In the earlier stages of dementia, a resident can often answer questions about their pain. It helps to ask simple questions and to rephrase how you ask those questions. Examples: Are you having pain? Do you hurt? Show me where it hurts.

In the later stages of dementia, family members are often the best resource. Ask questions about the resident’s past experience with pain:

1. Is there anything in their history that could cause pain? (a diagnosis, injuries, past surgeries, etc.)
2. How do they typically act where they’re experiencing pain?
3. What has been helpful in relieving pain in the past?
4. Which pain medications have they used and were there any negative side effects?

Several formal pain assessments may be helpful. These are two examples that rely on observations by caregivers:

PAINAD

Abbey

Medications:

It’s often best to ask that pain medications be prescribed on a scheduled basis rather than prn (only as needed) for a person living with dementia. This is because they might not know how to ask for a prn medication. Furthermore, they could be in pain for quite a while before we recognize the signs.

It’s a good idea, however, to have a prn pain medication available to give before procedures that could trigger pain. This might include a bath, dressing change, or physical therapy session.

With the recent concern about the opioid crisis, I think many medical providers are skittish about prescribing stronger pain medications for people living with dementia. However, addiction issues and drug-seeking problems are extremely unusual with a diagnosis of dementia.

Any medication can cause adverse side effects. A pharmacist is a great resource to provide information on various analgesic options. They can also provide information on recommended dosages and forms (topical, tablet, liquid, patch, etc.).

The hospice team also may help. They have enormous expertise in pain control, and even if a resident might not yet qualify for hospice services, the physicians and nurses are often willing to provide suggestions.

Other approaches:

There are many other interventions to help relieve pain for someone living with dementia:

1. Massage
2. Repositioning
3. Pet therapy
4. Distraction with meaningful activities
5. Music
6. Gentle exercise
7. Aromatherapy
8. Touch (hug, hold hand)
9. Warm blanket

We need to watch the resident’s response and communicate what works and what doesn’t work. If one approach doesn’t provide relief, we must keep on trying until we find something that’s effective.

If left untreated, pain often leads to long-term negative consequences. This includes weight loss, decreased mobility, depression, and poor sleep.

Even though we can’t cure the underlying dementia, we owe it to our residents to help them remain comfortable so they can experience the best quality of life possible.

We’re here to learn from each other. What other suggestions can you share to help relieve pain for those living with dementia? 

*Here’s a free dementia care printable to share with caregivers.*