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Spotlight on pain in a person living with dementia

It is widely recognised that when we are in pain we are not ourselves we are not comfortable, some of the words often used to describe pain that we hear are ‘sore’, ‘tender’ or ‘throbbing’ we will do anything to ease that feeling of discomfort whether it be dental pain or pain due a broken bone; ultimately the experience of pain is far from pleasant.

How do we react when we are in pain? Are we irritable or maybe angry? When it comes to people living with dementia sometimes there can be a loss in the ability to express pain, as a result this can then lead to undetected pain. Pain can be one of the reasons why a person living with dementia may exhibit agitation or signs of a distressed reaction. This could range from behaviours such as pacing, confusion, calling out, anxiety or waking up in the night. Pain should always be taken into account as a possible reason for this behaviour. We are all individuals and will all behave differently when we experience pain. People living with dementia are also going to experience these feelings however they are often not detected as pain, and can be mistaken for behavioural symptoms of dementia and a result a person living with dementia can be inappropriately treated for their behavioural symptoms when maybe this behaviour is a due to expression of pain. It is estimated that over 50% of older adults living with dementia in nursing-home settings live with chronic pain but only half receive medicines for pain relief (Jones and Mitchell, 2015). We can improve our awareness of pain in the people that we look after if we get to know them as individuals, I think that working in a care home setting we are very in a very privileged position in that we are able to build and develop relationships with the people we are looking after and get to know them.

So what can we do?

We have a range of ways in which we can detect pain in a person living with dementia. One of our best used tools is the Abbey Pain Scale, this is a tool which detects pain in a person. We all have different pain and sensation tolerances and experience them differently. The abbey pain scale looks at an individual’s behaviours. It is broken down into the following categories vocalisation, facial expression, change in body language, behavioural change, physiological changes and physical changes. This is then scored on a numerical basis in order to score the severity of the pain and whether this pain is potentially chronic, acute or acute on chronic. This is a guideline and in order to be used effectively, staff should ensure that they are using this consistently especially after the administration of analgesia in order to measure the effectiveness of the analgesia, always seeking further medical intervention if needed. We should always be mindful that one individual person living with dementia is still a unique individual, we should keep in mind that when we see distress that there is the potential that this can be a reaction to the unmet need of pain. We should also use what we know about our residents based on the relationship we have built with them, if there is a change in behaviour look at how that person may be feeling what are they doing or what are they saying. “Pain is often described as a private experience but in reality it requires a public expression in order to obtain relief”

(Closs SJ, Dowding D, Allcock N, et al. 2016)

Date published: 15 September 2017

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