Pain management in patients with dementia

Figures & data

Figure 1 A model of challenges in pain management in patients with dementia.

Table 1 Common pain behaviors in cognitively impaired elderly persons according to the AGS Panel on persistent pain in older persons³⁸

1. Facial expressions	Slight frown; sad, frightened face
	Grimacing, wrinkled forehead
	Closed or tightened eyes
	Any distorted expression
	Rapid blinking
2. Verbalizations, vocalizations	Sighing, moaning, groaning
	Grunting, chanting, calling out
	Noisy breathing
	Asking for help
	Verbally abusive
3. Body movements	Rigid, tense body posture, guarding
	Fidgeting
	Increased pacing, rocking
	Restricted movement
	Gait or mobility changes
4. Changes in interpersonal interactions	Aggressive, combative, resisting care
	Decreased social interactions
	Socially inappropriate, disruptive
	Withdrawn
5. Changes in activity patterns or routines	Refusing food, appetite change
	Increase in rest periods
	Sleep, rest pattern changes
	Sudden cessation of common routines
	Increased wandering
6. Mental status changes	Crying or tears
	Increased confusion
	Irritability or distress

Table 2 Recommendations to improve pain assessment and management in nursing homes⁵⁶

1.	Include an initial needs assessment of current pain care practices, formation of a pain quality improvement team guided by a systematic implementation process model, identification of clear quality indicators, and an ongoing educational component
2.	Use evidenced-based clinical decision-making algorithms for assessing and treating pain in persons with dementia
3.	Collaboratively engage all members of the care team, including residents, nurses at all levels within the organization, prescribers, medical directors, direct care workers, pharmacists, and families when considering pain care process changes
4.	Specifically target team-building with a goal of facilitating improvements in communication between prescribers and nurses about pain care in particular
5.	Incorporate a plan for regular periodic evaluation of pain management processes (eg, documentation of pain assessments and administration of analgesic medications on a scheduled basis) and resident outcomes, particularly pain severity and satisfaction, into efforts to ensure ongoing implementation of new practices
6.	Use consultants with expertise in pain management and process improvement strategies for on-site consultation

Figure 2 Studies on the prevalence (in %) of analgesic use in patients with dementia compared with in cognitively unimpaired patients (no dementia).

AGS Panel on Persistent Pain in Older PersonsThe management of persistent pain in older personsJ Am Geriatr Soc200250Suppl 6S205S22412067390

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SwaffordKLMillerLLTsaiPFHerrKAErsekMImproving the process of pain care in nursing homes: a literature synthesisJ Am Geriatr Soc20095761080108719507298

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