Many people with Alzheimer’s disease have been administered less pain medication than peers with no dementia who suffer from similar painful diseases or injuries. Since people in the later stages of Alzheimer’s can’t communicate well other than by generally acting in an aggressive manner, they can’t self-report pain. Some professionals have, in the past, concluded that the neurodegeneration caused by the disease must lower the sensitivity to pain, so they administer less medication for pain relief.
An Australian study has indicated otherwise. The study, conducted at Howard Florey Institute, University of Melbourne, measured pain ratings and functional MRI (fMRI) brain responses following mechanical pressure simulation in 14 patients with Alzheimer’s disease and 15 age-matched controls.
The analyses of this study showed no evidence of diminished pain-related activity in Alzheimer’s disease patients compared with controls. In fact, in this group, people with Alzheimer’s showed greater strength and duration of pain-related activity in sensory, affective and cognitive processing regions of the brain than the control group.
The final result of this study shows that pain perception and processing are not diminished in people with Alzheimer’s disease. This fact raises concerns that there may be inadequate treatment of pain when treating these exceptionally vulnerable people.
Take something as common as osteoarthritis as an example. The Centers for Disease Control and Prevention (CDC) reports that 50 percent of people 65 and over suffer from some degree of osteoarthritis**.** While some of these people may only suffer minor aching, even that can be an irritant. However, more troubling is the fact that advanced osteoarthritis can cause excruciating pain. Visualize your dad, in late stage Alzheimer’s, sitting in a wheelchair much of the day. He rarely moves, but when the caregiver tries to shift his position he yells and becomes combative. Could his combative behavior be the result of osteoarthritis pain that he can’t express any other way?
The takeaway from this Australian study is that people with dementia of any kind should be carefully monitored for pain and given the opportunity for as much pain control as anyone who could express themselves would receive. When people with dementia act out in what is considered inappropriate ways it’s always possible that they may be in pain and should be treated with this potential in mind.
Indeed, the aggression of many people with Alzheimer’s can be due to frustration or other unknown causes. However pain as a cause should not be overlooked simply because people with later stage Alzheimer’s can’t tell the caregiver what hurts. I’d like to see more research and education in this area. Many forward looking caregivers believe that all individuals who cannot self-report pain need to be monitored for the possibility that negative body language and acting out may be caused by pain that could be controlled. The Australian study gives substance to this concept.
Cole, L. (2008) Howard Florey Institute, University of Melbourne, Pain perception and processing in ageing. Retrieved from https://brain.oxfordjournals.org/content/129/11/2957.full
Cole, L. (2006) Pain sensitivity and fMRI pain-related brain activity in Alzheimer’s disease. Howard Florey Institute, University of Melbourne. Retrieved from https://brain.oxfordjournals.org/content/129/11/2957.full
King, M. (2013, August 25) Identifying Pain in the Person With Alzheimer’s. Suite101.com.Retrieved from https://suite101.com/article/identifying-pain-in-the-person-with-alzheimers-a203141
DeNoon, D. (2006, September 22). Pain a Problem in Alzheimer’s Disease: Undertreated Pain Plagues Alzheimer’s Patients Who Hurt, but Can’t Tell. WebMD. Retrieved from https://www.webmd.com/alzheimers/news/20060922/pain-problem-in-alzheimers-disease
Carol Bradley Bursack is a veteran family caregiver who spent more than two decades caring for a total of seven elders. She is a newspaper columnist and the author of Minding Our Elders: Caregivers Share Their Personal Stories. Bradley Bursack is also a contributor to several books on caregiving and dementia, and is passionate about preserving the dignity of elders. Her website is www.mindingourelders.com. Follow Carol on Twitter @mindingourelder and on Facebook at Minding Our Elders.