Pain is common among people living with dementia: up to 80% of residents in residential aged care experience chronic pain, and 52% of those residents have a diagnosis of dementia[1]. However, the inability to self-report means pain often goes undetected or inadequately treated in people living with dementia[2].
Knowing how to assess the level of pain in those who cannot verbalise, or whose ability to verbalise fluctuates, is a critical first step in providing a best-practice approach to pain management.
In this article, we explore the complexities of pain assessment in adults with dementia and the role of modern pain scale assessment tools.
How pain affects people with dementia
According to Dementia Australia, the changes in the brain that occur in people with Alzheimer’s disease and other forms of dementia do not cause pain[3]. However, people living with dementia are at an increased risk of experiencing pain as they are more likely to suffer from age-related medical conditions and are more prone to accidents and injuries.
Research has shown that pain affects people with dementia in much the same way as people without dementia. A study conducted in Melbourne used MRI technology to examine brain activity in people with Alzheimer’s disease and found that pain-related brain activity occurred in the same regions as those without Alzheimer’s disease[4].
The researchers concluded that, although pain is frequently experienced by those with dementia, effective pain assessment is hindered by the inability to communicate it to others.
Additionally, untreated pain can lead to behaviours such as aggression and withdrawal. In many cases, these behaviours are misdiagnosed as psychological illnesses and result in inappropriate treatment with antipsychotic medication.
Ultimately, failure to accurately assess and treat pain in people with dementia has major implications for their quality of life.
Recognising non-verbal signs of pain
Knowing how to recognise pain in those who cannot self-report is a crucial part of a carer’s role. Even if a person has some ability to communicate their pain, observing non-verbal signs can assist in a more comprehensive pain assessment.
According to Dementia Australia, some of the most non-verbal signs of pain in those with dementia include:
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- Facial grimacing
- Gestures that indicate distress
- Guarding a particular body part or reluctance to move
- Moaning with movement
- Limited range of motion or slow movement
- Increased heart rate, blood pressure, or sweating
- Restlessness
- Crying or distress
- Increased or decreased vocalisations
- Withdrawn social behaviour
- Lethargy or increased sleep
- Disrupted or restless sleep
- Decreased appetite (and decreased nutritional intake)
- Increased confusion
- Anger, aggression, irritability, or agitation
While these signs may be indicative of other medical concerns, pain should always be considered as a potential (and treatable) cause.
The value of pain scale assessment tools
Self-reporting is considered the gold standard of pain assessment, however, this approach is not appropriate for those who are unable to reliably verbalise their pain. Further challenges can arise where carers lack the training, time, or consistent relationship with a resident to recognise, assess and monitor their non-verbal signs of pain.
Pain scale assessment tools assist in overcoming these challenges by recording and scoring signs of pain in people who cannot communicate verbally, or whose ability to communicate fluctuates.
PainChek Universal, for example, utilises AI and smartphone technology to analyse facial movements, vocalisations, and other behaviours indicative of pain, and calculate a pain score based on these inputs. It also includes a Numeric Rating Scale (NRS) for those who can self-report, with key pain assessment data available at the individual, facility, and provider level.
An independent evaluation found using PainChek led to a reduction in the use of psychotropic medication through identifying pain as a cause of challenging behaviour. It was also found to improve the diagnosis and management of pain, quality of life, and/or healthcare outcomes in people living with dementia in residential aged care.
There are certainly challenges inherent to assessing pain in people living with dementia. However, modern pain scale assessment tools are paving the way forward for enhanced treatment outcomes and quality of life for this vulnerable group.
Interested in learning more about integrating PainChek with your existing care systems? Get in touch with our team today.
