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Home > Managing Pain in Patients with Cognitive Deficits & Dementia – Part I

Managing Pain in Patients with Cognitive Deficits & Dementia – Part I

Jenny L.F. Andrus, MDJenny L. F. Andrus, MD 

Dementia or noticeable declines in cognitive function, pose unique challenges in pain management. Patients with dementia often struggle to communicate their pain effectively, leading to underdiagnosis and undertreatment. Well-meaning spouses, relatives and friends may do their best to understand that something is wrong but may or may not completely or accurately address the pain that their person with dementia is experiencing.

Dementia affects how patients perceive and express pain. The cognitive decline can alter pain thresholds, with some patients experiencing heightened sensitivity while others may have a diminished response. Memory impairments also mean patients might not remember or articulate their pain experiences accurately. Managing pain in this vulnerable population requires a different approach that considers the patient’s cognitive limitations, while looking for known pain indicators and working toward their overall well-being while treating their pain effectively.

The Role of Care Givers

People who provide care for those who have dementia or cognitive decline can be the first to recognize signs of pain or discomfort in those for whom they provide care. Not all patients will be non-verbal, and may vocalize feelings of pain, discomfort, or unwellness.  Sometimes, pain can cause depression.  Some signs of which to be aware:

  • Depressed mood and lack of interest
  • Lack of appetite – even for ice cream, cake or other treats
  • Weight loss
  • Sleeping more than usual
  • Isolation
  • Crying

Other Non-Verbal Indicators

Non-verbal cues become critical in assessing pain in patients with cognitive decline and dementia. Indicators include:

  • Facial expressions: Grimacing or frowning
  • Body language: Restlessness, guarding, or rigidity
  • Vocalizations: Moaning, groaning, or increased agitation
  • Changes in behavior: Withdrawal, aggression, or decreased mobility

Whenever these signs are noticed and persist, medical care should be sought in order to address the issue, whether it be depression, depression due to pain, or simply a pain issue.  In the next article of the series, I will talk about several tests that I use as a physician to measure pain in individuals who have cognitive deficits and/or dementia and how these tools help me to ascertain a diagnosis and what treatment to apply.




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