The guide for caregivers
Dementia and Chronic Pain
Dementia and Chronic Pain
Understanding dementia-related pain
Assessing pain
Pain management strategies
narration
Understanding dementia-related pain
How common is dementia-related pain?
Dementia increases likelihood of pain. 50% to 80% of patients with moderate to severe dementia experience daily pain.
Is dementia-related pain easy to recognize?
Cognitive decline can affect communication and facial expressions, making it challenging to recognize pain in patients.
What happens if pain is left untreated?
Untreated pain can worsen cognitive decline and increase withdrawal, fatigue, and disrupt sleep in some patients. Others may become agitated, aggressive, and resistant to care.
narration
Types of dementia-related pain
Pain could be a symptom of the disease itself, a side effect of medication, or it could result from coexisting medical conditions. Click on the circles below to learn more.
Musculoskeletal pain
Psychological or emotional pain
Headaches
Dental pain
Skin pain
Abdominal pain
Sensory sensitivity
Neuropathic pain
narration
Read more
Signs of dementia-related pain
Identifying pain in people who live with dementia can be challenging, due to communication difficulties and changes in behavior. Here are some signs that a person might be in pain:
Facial expressions: Look for grimacing, wincing, or furrowing of the brow. Vocalizations: Listen for moaning, groaning, frequent sighing, or calling out. Changes in behavior: Note agitation, restlessness, pacing, or increased aggression. Sleep disturbances: Look for sleeping issues, frequent waking, or changes in sleep patterns.
Video: Teepa Snow on End of Life Care
narration
Hypertension in dementia
Hypersensitivity in dementia often appears as excessive itching and scratching. Dementia care expert Teepa Snow explains, “The itch is a hypersensitivity on your skin. Your skin is a sensory organ, and it has lots of sensors all over it.”
In certain dementias, such as Lewy body dementia, the brain sensory system becomes overactive, so normal sensations like hair movement, skin dryness, or friction may be misinterpreted as an itch. Scratching can lead to cycles of skin picking and scabbing.
TIPS FOR CAREGIVERS
narration
A scale for assessing pain in advanced dementia
While those in early stages of dementia are often able to rate their pain on a scale of 1 to 10, people living with moderate to advanced dementia are generally unable to do so. Tools like the Pain Assessment In Advanced Dementia (PAINAD) scale can be useful in understanding whether someone is in pain by paying attention to a few visual and aural queues.
narration
Prescription and over-the-counter pain treatments
Different medications are used to manage dementia-related pain. They have side effects and risks, so consult your doctor to find the best option for the person you're caring for. Consider the person's other medications as well.
Antidepressants
Acetaminophen
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Anticonvulsant medications
Opioids
narration
Prescription and over-the-counter pain treatments
When deciding what medication is right for a patient, a doctor will consider:
- The person’s overall health
- Medication tolerance
- The risk of adverse effects
- Potential drug interactions
narration
Read more on beingpatient.com
Read more on beingpatient.com
When painkillers raise risks: Opioids in dementia
When over-the-counter medications like Aspirin or Aleve aren’t enough, doctors may prescribe opioids: a class of notoriously addictive painkillers. But are they safe for people living with dementia? Research presented at the 2023 Alzheimer’s Association International Conference finds they have even higher risks than for cognitively healthy individuals. In fact, adults with dementia are eleven times more likely to die within the first two weeks of taking opioids. After the first two weeks, people with dementia still have a six-times-higher chance of dying.
“Opioids are known to have significant side-effects including sedation, confusion, respiratory depression and falls. Opioids should generally be used for the shortest possible time as they carry significant risk. If a patient with dementia is on an opioid it makes sense for the caregiver to discuss risk and benefits with their doctor. In some cases, the patients are in severe pain and clearly benefit from opioid therapy and in this case opioid would be indicated as discontinuation could lead to worsening of quality of life.”
Christina Jensen-Dahm
Copenhagen University Hospital
narration
Read more
Read more on beingpatient.com
Read more on beingpatient.com
Non-pharmacological pain treatment
Non-pharmacological therapies can also play an important role, especially when pain medications might not be suitable — or when these treatments are used in combination with pain medications.
Cognitive-behavioral therapy (CBT)
Music therapy
Physical therapy
Gentle massage
narration
The “ALTER” approach to pain management
Ask about pain regularly.
Routinely ask whether the person they're caring for is in pain.
Listen to verbal and non-verbal cues.
Pay attention to verbalizations, facial expressions, body language, and other signs that could indicate pain or discomfort.
Try different pain management strategies. Explore all your options to find the best way to manage pain while reducing side effects.
Empower individuals to communicate pain. Give your person opportunities to express their pain preferences and needs, i.e. communication aids including gestures, noises, etc.
Rapidly address pain. Continuously reassess and adjust pain management strategies for comfort and quality of life.
narration
Read more
Want to keep learning?
Visit
beingpatient.com
for the latest news and information on brain health and Alzheimer's disease
narration
Step one: rule out medical causes such as drug reactions, bacterial or yeast infections, or general skin dryness. Staying hydrated and consistent skin care can help reduce sensitivity. Additionally, Snow emphasizes the importance of engaging patients in activities that occupy their hands and minds, which can distract from the sensation: “Sometimes you can have them do things that engage their hands and brains in such a way that they are taken away from the sensation.”
!! - Dementia and Chronic Pain
Deborah Kan
Created on March 30, 2024
Start designing with a free template
Discover more than 1500 professional designs like these:
View
Discover Your AI Assistant
View
Vision Board
View
SWOT Challenge: Classify Key Factors
View
Explainer Video: Keys to Effective Communication
View
Explainer Video: AI for Companies
View
Corporate CV
View
Flow Presentation
Explore all templates
Transcript
The guide for caregivers
Dementia and Chronic Pain
Dementia and Chronic Pain
Understanding dementia-related pain
Assessing pain
Pain management strategies
narration
Understanding dementia-related pain
How common is dementia-related pain?
Dementia increases likelihood of pain. 50% to 80% of patients with moderate to severe dementia experience daily pain.
Is dementia-related pain easy to recognize?
Cognitive decline can affect communication and facial expressions, making it challenging to recognize pain in patients.
What happens if pain is left untreated?
Untreated pain can worsen cognitive decline and increase withdrawal, fatigue, and disrupt sleep in some patients. Others may become agitated, aggressive, and resistant to care.
narration
Types of dementia-related pain
Pain could be a symptom of the disease itself, a side effect of medication, or it could result from coexisting medical conditions. Click on the circles below to learn more.
Musculoskeletal pain
Psychological or emotional pain
Headaches
Dental pain
Skin pain
Abdominal pain
Sensory sensitivity
Neuropathic pain
narration
Read more
Signs of dementia-related pain
Identifying pain in people who live with dementia can be challenging, due to communication difficulties and changes in behavior. Here are some signs that a person might be in pain:
Facial expressions: Look for grimacing, wincing, or furrowing of the brow. Vocalizations: Listen for moaning, groaning, frequent sighing, or calling out. Changes in behavior: Note agitation, restlessness, pacing, or increased aggression. Sleep disturbances: Look for sleeping issues, frequent waking, or changes in sleep patterns.
Video: Teepa Snow on End of Life Care
narration
Hypertension in dementia
Hypersensitivity in dementia often appears as excessive itching and scratching. Dementia care expert Teepa Snow explains, “The itch is a hypersensitivity on your skin. Your skin is a sensory organ, and it has lots of sensors all over it.” In certain dementias, such as Lewy body dementia, the brain sensory system becomes overactive, so normal sensations like hair movement, skin dryness, or friction may be misinterpreted as an itch. Scratching can lead to cycles of skin picking and scabbing.
TIPS FOR CAREGIVERS
narration
A scale for assessing pain in advanced dementia
While those in early stages of dementia are often able to rate their pain on a scale of 1 to 10, people living with moderate to advanced dementia are generally unable to do so. Tools like the Pain Assessment In Advanced Dementia (PAINAD) scale can be useful in understanding whether someone is in pain by paying attention to a few visual and aural queues.
narration
Prescription and over-the-counter pain treatments
Different medications are used to manage dementia-related pain. They have side effects and risks, so consult your doctor to find the best option for the person you're caring for. Consider the person's other medications as well.
Antidepressants
Acetaminophen
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Anticonvulsant medications
Opioids
narration
Prescription and over-the-counter pain treatments
When deciding what medication is right for a patient, a doctor will consider:
narration
Read more on beingpatient.com
Read more on beingpatient.com
When painkillers raise risks: Opioids in dementia
When over-the-counter medications like Aspirin or Aleve aren’t enough, doctors may prescribe opioids: a class of notoriously addictive painkillers. But are they safe for people living with dementia? Research presented at the 2023 Alzheimer’s Association International Conference finds they have even higher risks than for cognitively healthy individuals. In fact, adults with dementia are eleven times more likely to die within the first two weeks of taking opioids. After the first two weeks, people with dementia still have a six-times-higher chance of dying.
“Opioids are known to have significant side-effects including sedation, confusion, respiratory depression and falls. Opioids should generally be used for the shortest possible time as they carry significant risk. If a patient with dementia is on an opioid it makes sense for the caregiver to discuss risk and benefits with their doctor. In some cases, the patients are in severe pain and clearly benefit from opioid therapy and in this case opioid would be indicated as discontinuation could lead to worsening of quality of life.”
Christina Jensen-Dahm
Copenhagen University Hospital
narration
Read more
Read more on beingpatient.com
Read more on beingpatient.com
Non-pharmacological pain treatment
Non-pharmacological therapies can also play an important role, especially when pain medications might not be suitable — or when these treatments are used in combination with pain medications.
Cognitive-behavioral therapy (CBT)
Music therapy
Physical therapy
Gentle massage
narration
The “ALTER” approach to pain management
Ask about pain regularly.
Routinely ask whether the person they're caring for is in pain.
Listen to verbal and non-verbal cues.
Pay attention to verbalizations, facial expressions, body language, and other signs that could indicate pain or discomfort.
Try different pain management strategies. Explore all your options to find the best way to manage pain while reducing side effects.
Empower individuals to communicate pain. Give your person opportunities to express their pain preferences and needs, i.e. communication aids including gestures, noises, etc.
Rapidly address pain. Continuously reassess and adjust pain management strategies for comfort and quality of life.
narration
Read more
Want to keep learning?
Visit
beingpatient.com
for the latest news and information on brain health and Alzheimer's disease
narration
Step one: rule out medical causes such as drug reactions, bacterial or yeast infections, or general skin dryness. Staying hydrated and consistent skin care can help reduce sensitivity. Additionally, Snow emphasizes the importance of engaging patients in activities that occupy their hands and minds, which can distract from the sensation: “Sometimes you can have them do things that engage their hands and brains in such a way that they are taken away from the sensation.”