Role of Nurses in Pain Management in Patients Affected with Dementia
Pain is a common and distressing symptom for many older adults, especially those who have dementia. However, pain is often under-recognised and under-treated in this population, leading to unnecessary suffering and reduced quality of life. Nurses play a vital role in assessing and managing pain in patients with dementia, both in hospital and community settings. This blog post will discuss some of the challenges and strategies for effective pain management for patients with dementia, based on current evidence and best practice guidelines.
Challenges of Pain Assessment in Patients with Dementia
One of the main challenges of pain assessment in patients with dementia is their difficulty in communicating their pain experience verbally. Patients with dementia may have impaired memory, language, attention, and cognition, which can affect their ability to report pain location, intensity, duration, and quality. They may also have reduced awareness or insight into their pain, or may not remember or understand the purpose of pain assessment tools. Therefore, relying solely on patients’ self-report of pain may not be sufficient or accurate for this group.
Another challenge is the lack of valid and reliable pain assessment tools for patients with dementia. Many of the existing tools are designed for cognitively intact older adults or younger populations, and may not capture the specific features or manifestations of pain in patients with dementia. For example, some tools may use complex or abstract words or concepts that patients with dementia may not comprehend or recall. Some tools may also require patients to rate their pain on a numerical or visual scale, which may be difficult for patients with dementia to use or interpret.
Furthermore, pain assessment in patients with dementia may be influenced by various factors, such as the type and stage of dementia, the presence of comorbidities or medications, the environment or context of assessment, and the relationship between the patient and the assessor. These factors may affect how patients express or respond to pain, as well as how assessors interpret or perceive their pain cues. For instance, patients with dementia may show behavioral changes, such as agitation, restlessness, aggression, or withdrawal, when they experience pain. However, these behaviors may also be caused by other factors, such as delirium, infection, hunger, thirst, boredom, or unmet needs. Therefore, it is important to consider the possible causes and meanings of patients’ behaviors when assessing their pain.
Strategies for Pain Assessment in Patients with Dementia
To overcome these challenges, nurses need to adopt a comprehensive and holistic approach to pain assessment in patients with dementia. This involves using multiple sources and methods of information gathering, such as:
– Asking patients about their pain directly whenever possible, using simple and clear questions or statements that are appropriate for their cognitive level and language ability. For example, asking “Are you hurting?” or “Show me where it hurts” rather than “How would you rate your pain on a scale of 0 to 10?”.
– Observing patients’ behaviors, facial expressions, body movements, vocalizations, and physiological changes that may indicate pain or discomfort. For example, looking for signs of grimacing, frowning, moaning, groaning, rubbing, guarding, limping, sweating, or increased heart rate or blood pressure.
– Using validated pain assessment tools that are specifically designed for patients with dementia or cognitive impairment. For example, using tools such as the Pain Assessment in Advanced Dementia (PAINAD) , the Doloplus-2 , or the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) , which are based on observable indicators of pain rather than self-report.
– Consulting family members or carers who know the patient well and can provide information about their usual behavior patterns, preferences, likes and dislikes,
