1. Understanding Pain in Dementia
Audrey Melrose
Alzheimer Scotland Nurse Consultant for Dementia
NHS Forth Valley
3rd October 2014
AMelrose ASNCD 3rd October, 2014

2. Pain?
AMelrose ASNCD 3rd October, 2014

3. Pain HURTS Discomfort distress agony throbbing
Stabbing aching pinching
“Pain is a very personal, subjective, perception”
Dr Shibley Rahman 2014
AMelrose ASNCD 3rd October, 2014

4. Pain Activation in the Brain (Schweinhardt & Bushnell, 2010)
Multiple areas activated (Pain Matrix)
Brain encodes details (location, intensity, emotional association)
Influenced by attention, distraction, manipulation & mood
Structural brain changes seen in chronic pain
Damage to Pain Matrix changes pain perception
(Luis Garcia-Larrea & Roland Peyron 2013)
AMelrose ASNCD 3rd October, 2014

5. Physical Pain Intense Heat Nociceptive pain Warm Temperatures
Dr Clifford J Woolf, 2010
Intense Heat
Warm Temperatures
System Malfunction
Nociceptive pain
Inflammatory pain
Pathological pain
AMelrose ASNCD 3rd October, 2014

6. Emotional / Psychological Pain
“A mental suffering: mental torment”
(Edwin S Shneidman 2013)
AMelrose ASNCD 3rd October, 2014

7. Emotional Pain Emotional pain worse than physical
Paid less attention
Recollection of emotional pain is greater
Physical pain detracts from emotional pain not vice versa
More “Echo’s” to reactivate pain
Causes damage to self esteem & mental health
(Dr Guy Winch 2014)
Less empathy from others
AMelrose ASNCD 3rd October, 2014

8. Social Effects of Pain Withdrawal Fear to avoidance
Loss of self esteem
Distraction
Irritability
Loss of contacts
AMelrose ASNCD 3rd October, 2014

9. Research – Pain in Dementia (Dr Ann Corbett 2011)
Lack of research
Undertreated or inappropriately treated
Analgesics not enough
Type of pain relief needs fully assessed
Staff need formal training in pain assessment
2/3 of Care homes under-estimate the number of residents experiencing pain.
Alzheimer Society Survey 2013
AMelrose ASNCD 3rd October, 2014

10. Pain in Dementia Impaired ability to describe symptoms
Possible difficulty conceptualising pain
Problems accepting medication
Recognising pathological pain
AMelrose ASNCD 3rd October, 2014

11. Assessing Pain in Dementia
Encourage self reporting
Use validated observational assessment tools
If assessment positive, assess other needs: hunger, thirst, stimulation, toilet, anxiety, bored, lonely
Identify source/sources of pain
Dr Amy Denham 2013
AMelrose ASNCD 3rd October, 2014

12. Behaviour as an Indicator
Interactions-
Withdrawn, Combative, resistant, aggressive, clingy
Routine-
Sleep pattern
Appetite
Stopping usual routine
Mental State
Crying
Irritable
Distress
Confusion
AMelrose ASNCD 3rd October, 2014

13. Treatment The Norwegian Trial (352 residents/60 care homes)
Professor Clive Ballard 2011
Reduced Agitation & Distress by 17%
Careful assessment and review
Need for ascending analgesic protocol
Regular and frequent analgesics
Simple analgesia more effective than Antipsychotics for symptoms of agitation
AMelrose ASNCD 3rd October, 2014

14. Analgesia is not enough
Holistic Care
Analgesia is not enough
Dr Ann Corbett 2011
Short, frequent, and positive social interaction
Distraction, stimulation, laughter
Talk, listen, touch, respond, comfort,
but most of all:
Care
AMelrose ASNCD 3rd October, 2014

15. Henri Nouwen, 2013
AMelrose ASNCD 3rd October, 2014