A Dementia Dilemma: Inability to Recognise and Communicate Pain
Pain is a common but complex experience that differs from person to person. Pain is always a subjective experience. So when someone has dementia how does this affect their experience of pain and how they express their reaction to it? How can caregivers know when pain relief is required and is effective?
Oosterman (2014) et al carried out a small pilot study looking at why people with dementia under-reported pain and why pain is so poorly identified in this group of patients by looking at their semantic memory. Semantic memory is a portion of long term memory that processes ideas and concepts and includes common knowledge that we accumulate over our lifetime. The researchers found that people with dementia have difficulties reporting pain because they are less able to identify painful situations and have more problems describing pain because of deficits in their semantic memory.
If common words lack meaning or curtail descriptors of pain in people with dementia it does pose problems in identifying both causes and locations of pain. It is something most caregivers will have seen. One common example is when people with dementia have serious urinary tract infections that most of us would find agonising but that seem not to cause the same reaction for them. People can have broken bones or deep cuts that are only identified by other symptoms. Careful observation and reporting other clinical evidence that might point to the need for pain relief become very important.
Pain is a big issue in good medical practice. A study published March 25th 2015 highlights, yet again, the under-reporting of pain in hospitalized people with dementia. An observational study of 230 people with dementia, this time from University College London found that, while 57 per cent of people with the condition were observed to experience pain, less than 40 per cent were able to report it due to the nature of their condition.
The researchers also found a strong association between pain, aggression and anxiety. Ninety per cent of people with dementia experience behavioral and psychological symptoms of dementia which can include agitation. If pain is a significant contributor to emotional distress we need to be alert to the fact that people with dementia may lack the standard mechanisms of reporting discomfort and further research is required to find appropriate clinical pain rating tools.
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