Is the old myth true that people with dementia have less sensitivity
or awareness of pain?
Is it a misconception that
people with dementia are in pain?
Or is the pain because of some
underlying issue that has yet to be diagnosed?
It is widely believed that Chronic pain is
persistent over time and may be due to an underlying long-term medical
condition such as arthritis. The pain
may be present all the time, or may come and go.
As far as the
medical profession know, the changes in the brain that occur in Alzheimer's disease and other forms of dementia do not cause pain.
As I started to look at what
was available for assessing and managing pain for people with dementia.
Unfortunately, I have found that there currently is not a lot of literature on
how to assess and treat pain in people with cognitive impairments. As we become aware of the importance of pain
management for all people, however, more helpful information will become
available.
Generally, we think of pain as
an acute situation—you break a bone, have surgery, sprain an ankle, etc. These
kinds of pain go away as we heal. Then there is the pain we associate with
major illness, e.g. cancer pain. Finally, there is chronic pain, which can come
from any number of sources, from neuropathy pain in diabetes to lower back pain
to jaw pain from grinding your teeth. People with dementia can have all or none
of these ailments. The problem is that they are often not able to tell us that
they are hurting. Yet, with proper pain management, our job as caregivers will
be easier.
So, how do we tell if a person
with dementia is in pain?
Sometimes we can push gently
on an area and ask if it hurts. Another way is to check for changes in facial
expression, such as grimacing. Behavioural
changes such as restlessness, agitation, vocalizations and even a faster heart
rate may be signs of discomfort.
Doing a proper pain assessment
takes time, and harried Doctors often don’t take the time to do such an
assessment.
Doctors often do lab tests to
rule out the major causes of discomfort, such as a pneumonia, prostate
problems, constipation or a urinary tract infection.
Further, everyone has a
different pain threshold, so a doctor who is unfamiliar with a patient might
not know how to "read" the person with dementia who cannot respond
verbally. Family members can be the best
advocates for their loved ones in this case.
In addition, elderly patients,
raised in an era when it was not appropriate to complain, may also not
acknowledge discomfort. Social and family norms about pain also play a role. In some families, half an aspirin is
considered major medication!
Untreated pain has now been
shown to be a co-factor effecting outcomes in other ailments, so treating it is
important for the patient at many levels. There are many methods to treat pain
when it is diagnosed. Pain management is usually started with anti-inflammatory
or mild analgesics, such as aspirin or Tylenol, but stronger medication may be
called for. Often people do not get good pain management for fear of addiction
to opioid medications, such as the Fentanyl patch or oxycontin. But there is
little incidence of addiction when the medication is taken properly for pain.
Anti-depressants are also often used, particularly for chronic pain such as
neuropathy, fibromyalgia, etc. Sometimes physical therapy, nerve blocks,
cortisone or muscle stimulation systems are helpful in dealing with muscular
pain.
It is important that if you
are concerned that your loved one is in pain, start by assessing for yourself
what the source of the pain might be.
Touching areas and asking if
it hurts is a good beginning.
When you have identified some
possibilities, the next step is to inform your loved one’s doctor that you
think he/she is in pain, explaining as much as you know about the pain
(a) when
it started,
(b) where
it is,
(c) how
much discomfort the person might be exhibiting.
What you want is for the doctor
to explore further the possible cause of the pain.
Lab tests can be helpful to
determine if the pain is from a urinary tract infection or a systemic
infection.
A physical exam can help the doctor
determine if something is swollen or an internal organ is enlarged.
If the doctor can determine
the cause of the pain, he/she can then consider treatments. If the doctor
cannot determine the cause of the pain, it might be necessary to work
proactively with the doctor to treat the pain even without a cause.
Be persistent in encouraging the doctor to try different
medications until there is relief for your loved one. If your loved one is a
candidate for hospice, the nurses and Doctors are experts on pain control and
will work together with you to make your loved one comfortable. Facilities are
required to have pain protocols, and if the nursing home or hospital is not assessing
your loved one, you can ask to see
their protocol.
their protocol.
Just because someone cannot
talk does not mean everything is okay. It is important for family members to
work together with Doctors and facilities to make sure that they are
evaluating, monitoring and treating pain in people with dementia.
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