Observation of Pain in Dementia

Abstract

Recognition of pain in older persons with dementia is a considerable challenge to quality pain care for this vulnerable population. Without recognition, pain cannot be thoroughly evaluated and effectively treated. Observing for pain-related behaviors is the most researched means of identifying the presence or likelihood of pain in persons with moderate to severe dementia, or those who are unable to self-report their pain. The purpose of this paper is to discuss the state of observation of pain, primarily focusing on pain behavior tool development, providing an overview of current pain tools and discussing the challenges at this stage of the science, including the issue of assessing pain intensity. We also recommend a number of areas to prioritize future research with the goal to advance effective pain assessment in older persons with dementia. Central to these recommendations is the refinement of existing tools to incorporate those behaviors most predictive of pain in persons with dementia as the science progresses in this area. The future of pain observation in dementia is poised for considerable advancement through these refinements of tools and techniques. Improving our ability to detect and evaluate pain in the vulnerable population unable to self-report their pain, through the results of these suggested research priorities, will likely assist in addressing the related suffering that results from unrecognized and untreated pain.

Facial Pain Expression in Dementia: A Review of the Experimental and Clinical Evidence

“…There is wide agreement that facial expressions represent the most sensitive and specific non-verbal signals of pain [3]. This prominent role is also reason enough to suggest the assessment of facial expressions of pain in patients with dementia, when they are no longer able to provide valid and reliable self-report of pain [4][5][6].…”

Pharmaceutical and Botanical Management of Pain Associated with Psychopathology: A Narrative Review

“…Recognition of pain in people with this condition should be considered because it changes the quality of life of patients. If they cannot recognize the pain, or cannot to verbalize it, they will not be evaluated or treated properly [31].…”

Editorial: Pain in Dementia: A Distressing Combination of Several Factors

“…Dementia has been called "the 21st century plague" because of the enormous projected rise in the worldwide prevalence from over 35 million now to over 115 million in 2050 [1]. Although, this raises many medical, psychosocial and societal challenges, the recognition and assessment of pain in patients with cognitive impairment provide us with a major and comprehensive challenge [2]. Especially in long term care institutions, the vast majority of people with dementia are thought to experience pain regularly [3].…”

“…One recent review concludes that there are 12 promising pain assessment tools instruments available, furthermore it states that most of them have not yet been validated enough to employ them in every-day clinical dementia care [12]. Most of the instruments are based on more or less the same pain concepts, but their operationalization and the way they are used are very heterogeneous [2]. One of the major problems in the development and validation of pain assessment tools is that they rely on behavioral symptoms of pain, which are very difficult to discriminate from behavior that is related to the dementia itself.…”

“…A voluminous second focus of this special volume targets the still existing huge problems in pain assessment and diagnosis in patients with dementia. The contribution of Herr et al, shows the dependency of proper pain assessment from systematic behavioral observations and the pressing need for the development of internationally agreed on reliable and valid assessment tools [2]. A very useful observational indicator of pain appears to be the facial expression.…”