Do individuals with dementia feel pain?

Dementia does not alter the fundamental experience of pain. In a recent summary of research published in the Journal of the American Geriatrics Society, however, elderly individuals with dementia who live in their own home or in a non-nursing home residential care setting experience more bothersome and activity-limiting pain than their peers who do not have dementia.

The characteristics of this “bothersome” pain included arthritis, heart and lung disease, depression and anxiety symptoms, and difficulty performing activities of daily living.

The findings suggested that individuals with dementia feel everyday pain, yet, because of the individual’s impaired ability to actually convey the unpleasant sensation, this pain often goes unrecognized and/or treated.

Other research done by the National Aging Institute at the University of Melbourne in Australia studying the brain activity of affected individuals showed that pain activity in the brain was just as strong in the individuals with Alzheimer’s as in the healthy study participants. The study concluded the pain activity actually lasted longer in the individuals with the disease. Oftentimes, the pain can be stemming from constipation or a urinary tract infection, which can cause great distress.

Pressure sores can arise from sitting or lying in one position too long, and weight loss from the disease progression can lead to ill-fitting dentures and sore gums. And, some individuals have undiagnosed fractures from unknown slips or falls that can be the source of discomfort.

Because of the individual’s impairment in expressing pain, it is important for the caregiver or healthcare professional to be aware of subtle changes in the affected individual’s mood or behavior that might indicate some kind of pain. Sudden behavior changes, for instance, such as fidgeting, pacing or restlessness can be indicators of pain.

Mood changes such as depression and withdrawal also can be indicators, as well as loud speech patterns, i.e., constantly shouting, screaming and/or crying. The caregiver or healthcare professional also needs to be conscious of body language and facial expressions.

When feeling some sort of pain, the affected individual may frown a lot, grimace, show tension or exhibit fear as well as try to show visible signs of pain by rubbing or holding on to the part of the body that is painful.

Recognition and treatment of pain in individuals with Alzheimer’s or dementia can be difficult, and caregivers and healthcare professionals play a vital role in observation of the individuals to anticipate the needs and to ensure comfort. If the source of pain is not obvious, the individual may need a thorough physical examination by a physician to ascertain the cause of discomfort and to provide a suitable treatment plan.

Contact Dana Territo, the Memory Whisperer, Director of Services at Alzheimer’s Services of the Capital Area, (225) 334-7494, advice@alzbr.org, or visit the organization at 3772 North Blvd., Baton Rouge.