From the Guidelines
Dementia patients do not feel less physical pain, but they may express it differently. Research indicates that individuals with dementia experience pain similarly to those without dementia, but their cognitive impairment often affects their ability to communicate their discomfort verbally 1. Instead, they might express pain through behavioral changes such as agitation, aggression, withdrawal, or changes in sleep patterns.
Key Points to Consider
- Healthcare providers should assess pain in dementia patients using observational tools like the Pain Assessment in Advanced Dementia (PAINAD) scale, which evaluates breathing, vocalization, facial expressions, body language, and consolability 1.
- Regular pain assessments are crucial since untreated pain can worsen cognitive function and quality of life.
- Pain management approaches should be individualized and may include both non-pharmacological methods (like heat therapy, gentle massage, or music) and appropriate medications such as acetaminophen as a first-line treatment, with careful consideration of other analgesics based on the individual's needs and potential side effects 1.
- The underlying neurological changes in dementia don't diminish pain sensation, but they do alter how pain is processed and expressed.
Important Considerations for Pain Management
- For patients with severe dementia, the Pain Assessment IN Advanced Dementia (PAINAD), the Functional Pain Scale, or Doloplus-2 are better than other tests 1.
- In non-verbal patients who cannot provide self-report, pain behaviors such as guarding and grimacing and input from family and caregivers associated with the Critical care Pain Observation Tool (CPOT) and Behavioral Pain Scale (BPS) are valid tools 1.
- Common analgesics used are opioids, non-opioids, paracetamol or acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs), with the type of analgesics used tailored according to the type of injury, pain severity, triage system, and patient’s clinical features 1.
From the Research
Pain Perception in Dementia Patients
- The relationship between dementia and pain perception is complex, with some studies suggesting that dementia patients may experience pain differently due to neuropathology and brain atrophy 2.
- However, it is also noted that pain is often underrecognized and undertreated in dementia patients, which can lead to unnecessary suffering and behavioral symptoms 3, 4.
Assessment of Pain in Dementia Patients
- Assessing pain in dementia patients is challenging due to their limited ability to self-report pain, making observational methods necessary 2, 3.
- Various pain assessment tools and protocols have been developed, but their psychometric quality and clinical utility are uncertain, and more research is needed to improve pain assessment in this population 2, 3.
Treatment of Pain in Dementia Patients
- The evidence for efficient treatment of pain in dementia patients with analgesics is limited, and more research is needed to determine the safest and most effective treatment options 2, 5.
- Nonpharmacological management programs, such as interdisciplinary collaboration and monitoring of pain and potential side effects, are recommended as a first-line approach 3, 6.
- Paracetamol is considered a relatively safe and effective first-choice analgesic, while nonsteroidal anti-inflammatory drugs, opioids, and adjuvant analgesics may have safety issues and require regular monitoring 3, 5.