Polypharmacy, commonly defined as the use of five or more medications, is one of the most significant challenges facing care and healthcare providers. Research shows that up to 91% of care home residents take more than five medicines.
Older adults, particularly those living with dementia, are especially vulnerable to the risks that come with multiple medications, including adverse drug reactions (ADRs), cognitive decline, falls, and preventable hospital admissions. Evidence shows that up to 28% of emergency department presentations are medicine‑related, and 70% of these could be avoided.
A frequently overlooked driver of inappropriate medication use is undiagnosed or undertreated pain. When people cannot self‑report, due to dementia, cognitive impairment, or communication difficulties, pain may present as agitation, vocalisation, withdrawal, or sleep disturbance. These behaviours are easily misinterpreted as psychiatric symptoms, leading clinicians to prescribe sedatives or antipsychotics instead of addressing the underlying pain.
Because 60 to 80% of people living with dementia regularly experience pain, the consequences of missing it are significant. Untreated pain contributes to:
- behavioural distress
- unnecessary sedative or antipsychotic use
- increased falls
- cognitive decline
- functional deterioration
- prescribing cascades
Improving pain identification is therefore key to breaking the cycle of inappropriate prescribing and reducing polypharmacy.
The connection between pain and polypharmacy
Polypharmacy becomes harmful when medications are used to treat symptoms caused by unrecognised pain. This leads to prescribing cascades, where one drug’s side effects are mistaken for a new condition:
Undetected pain → agitation → benzodiazepine → increased falls → more medications → avoidable hospitalisation
In dementia care, this chain reaction occurs frequently due to challenges with communication, behavioural interpretation, and inconsistent pain assessment tools.
How PainChek® transforms pain management
PainChek®, the world’s first regulatory‑cleared medical device for pain assessment, provides an objective pain score using AI‑driven facial analysis combined with clinical indicators. It enables clinicians to recognise pain in people who cannot self‑report, ensuring that behaviours are correctly interpreted and treated.
By making pain visible and measurable, PainChek:
- supports safer prescribing
- prevents inappropriate use of sedatives and antipsychotics
- reduces reliance on guesswork
- promotes timely and targeted pain treatment
- enables clinicians to intervene early and avoid escalation
This objective pain data is essential in medication reviews, deprescribing decisions, PRN protocols, and variable‑dose management.
Reductions in sedatives and antipsychotics
Accurate pain identification through use of PainChek has consistently demonstrated measurable reductions in high‑risk medication use across many care and clinical settings.
- 10% reduction in antipsychotic use across Orchard Care Homes’ estate
- 20% reduction in benzodiazepine and antipsychotic prescribing in an 18-month case study using PainChek with InterSystems
- 33% reduction in use of antipsychotics and 25% reduction in analgesics in a pilot study by the Scottish Care Inspectorate
- 58% reduction in benzodiazepines used across residents at Dovehaven Care Homes
Impact on hospitalisation risk and wellbeing
PainChek‑supported pain management in the Scottish Care Inspectorate pilot also resulted in:
- 40% fewer falls, a leading cause of hospital admission
- 27% reduction in dependency, reflecting improved mobility and function
- improved appetite, sleep, mood, and engagement
Preventing prescribing cascades
PainChek prevents prescribing cascades by clearly differentiating pain from psychiatric symptoms. When clinicians understand the true cause of distress:
- unnecessary sedatives are avoided
- confusion, sedation, and falls caused by those sedatives are prevented
- additional medications added in response to side effects are avoided
Supporting medication reviews and deprescribing
Objective, ongoing pain data from PainChek supports:
- safer tapering or discontinuation of sedatives
- more accurate differentiation between pain‑related behaviours and psychiatric conditions
- evidence‑based deprescribing
- multidisciplinary medication reviews with GPs, pharmacists, and nurses
How better pain management reduces multiple medication classes
When pain is accurately identified and treated, care providers and clinicians can often reduce or avoid additional medications that were previously used to manage secondary symptoms caused by undiagnosed or untreated pain. Indeed, data shows the positive impact PainChek can have on several key medication classes outside of analgesics and psychotropics.
Laxatives
PainChek‑supported care in the Scottish Care Inspectorate study showed a 34% reduction in laxative use.
Why pain affects laxative prescribing:
- Residents in pain may become less mobile, leading to constipation.
- Unidentified pain can also cause appetite reduction and gastrointestinal slowing.
When pain is treated, mobility improves, distress decreases, and gastrointestinal motility often normalises, reducing the need for laxatives.
Antidepressants
The same Scottish study found a 21% reduction in antidepressant prescribing following better digital pain assessment and management.
Why pain affects antidepressant use:
- Untreated pain can present as low mood, withdrawal, irritability, or apathy, often misinterpreted as depression.
- Effective pain management reduces these “pseudo‑depressive” symptoms, enabling deprescribing or avoiding new antidepressant prescriptions.
Sleep medications
Behavioural and sleep improvements resulting from pain management reduce the perceived need for sleep aids.
Why pain affects sleep medications:
- People with dementia frequently express pain at night through restlessness or poor sleep.
- Treating the pain (instead of sedating the symptoms) naturally reduces reliance on sedative‑hypnotics.
Gastrointestinal medications
Untreated pain, especially abdominal or generalised pain, can cause appetite changes, nausea, or discomfort. When pain is managed, appetite often improves (e.g., 47% increase in BMI scores in the Scottish study), reducing use of appetite‑related or GI medications.
Mobility‑related medications
Better pain control reduces stiffness and guarding, decreasing dependency, and reducing use of mobility support medicines.
In summary
Pain is one of the most common yet least recognised drivers of distress, inappropriate prescribing, and polypharmacy in dementia care. By enabling accurate, objective pain identification, PainChek:
- reduces sedative and antipsychotic use
- prevents prescribing cascades
- supports deprescribing
- reduces falls and ADR‑related hospital visits
- improves wellbeing and functional outcomes
- enables safer PRN and medication optimisation practices
Accurate pain assessment is a cornerstone of medication safety and a vital strategy for reducing polypharmacy and improving outcomes for people living with dementia.
For further guidance on reducing polypharmacy risks, download our essential new resource for care providers here.
