Dementia isn’t a single disease but a group of symptoms affecting memory, thinking, and daily functioning. Over 55 million people worldwide live with dementia, and around 60-70% of them have Alzheimer’s disease.
While memory loss is a leading symptom, there are many other effects, including confusion, difficulty planning, and physical decline. Many dementia patients we see at Kenneth K. Wogenson, MD, also experience pain. Addressing this pain not only improves a patient’s well-being but can also reduce stress for caregivers.
As dementia progresses, the likelihood of experiencing pain increases. However, recognizing pain in people with dementia is challenging because patients may no longer be able to verbally express their discomfort.
Additionally, Alzheimer’s disease often causes facial muscles to become less expressive, making it difficult to spot typical signs of pain like grimacing or frowning.
Instead of saying, “I’m in pain,” patients might exhibit distressing behaviors, such as:
Pain can also contribute to poor sleep, making patients feel even more fatigued.
Pain in dementia patients can stem from various sources, including:
Chronic pain lasting more than three months is common in dementia patients and can worsen cognitive decline.
Research suggests that pain and Alzheimer’s disease share some of the same brain pathways. Inflammation in the brain, particularly in the locus coeruleus, may contribute to both conditions. This means that even if a dementia patient doesn’t have an obvious injury, they could still be experiencing significant pain.
Patients with knee or hip replacements, back injuries, or conditions like arthritis may experience worsening pain because they move less. Reduced mobility can cause stiffness, joint pain, and muscle tightening (contractures). If patients avoid movement or resist repositioning, they may be experiencing pain.
Bedridden or immobile dementia patients are at high risk for developing pressure sores, which can be painful. These sores form when a person stays in one position for too long, cutting off circulation to the skin and tissues.
Heart disease, kidney disease, cancer, and other medical conditions can also cause pain. However, these types of pain can be harder to detect in dementia patients since they may not be able to describe chest pain, stomach aches, or other discomforts.
Dementia patients often experience emotional distress due to confusion, loss of independence, and social isolation. Grief, depression, and anxiety can manifest as headaches and other forms of physical pain, worsening their discomfort.
Because traditional pain scales requiring verbal feedback don’t work for many dementia patients, healthcare providers use tools like the Pain Assessment in Advanced Dementia Scale (PAINAD).
This scale evaluates pain based on signs such as breathing patterns and vocal expressions like moaning or crying. It’s important to watch for signs such as restlessness, rapid breathing, and guarding certain body parts.
When treating pain, we aim to use the lowest effective dose of medication. The type of medication depends on the nature of the pain, and some people may require a combination of drugs for better pain control.
Other approaches can also help relieve discomfort. Gently massaging sore joints or muscles can improve circulation and reduce pain. Aromatherapy scents like lavender and peppermint may promote relaxation and ease discomfort.
Playing a patient’s favorite music provides distraction and releases endorphins that help with pain relief. Interacting with a therapy animal can bring comfort and reduce stress.
Regularly changing a patient’s position helps prevent pressure sores and relieves discomfort from staying in one spot too long.
Caregivers play a critical role in recognizing and managing pain. Following the ALTAR approach can help you monitor and manage pain in loved ones with dementia:
Expect dementia patients to experience pain and regularly assess it.
Watch for behavioral and physical signs of pain, such as facial grimacing, restlessness, or resistance to movement.
Use non-medication methods when possible, and work with us to determine the best treatment plan.
Dementia changes how a person processes pain, so a patient who once had a high pain tolerance may now feel pain differently.
Pain management is an ongoing process. Regularly reassess pain and liaise with us to adjust treatments as needed.
By proactively assessing and managing pain, patients with dementia and their caregivers experience greater comfort and peace of mind. Call us for more information and support, or contact us using our online inquiry form.
