Reacting to untreated pain doesn’t justify the ‘Challenging Behaviour’ label!

When a person with dementia is in pain, and cannot articulate it, this can manifest in responsive behaviours that are out of character.

In this scenario it is often the adverse behaviour of the individual that is focused on, rather than the pain they may be experiencing which could be the underlying issue. As a result, pain can go under-treated or unrecognised—Dementia Support Australia approximate that up to 70% of their clients are living with under-treated or undiagnosed pain.

managing behaviours eventIt is thought that one in five Australians experience chronic pain, with the majority of these people being in aged care. McClean and Cunningham 2016 highlight the prevalence of pain in aged care homes to be up to 80%. The burden of untreated pain can have a huge negative impact on the individual’s quality of life, as well as affect their carers and families.

There are many definitions of ‘pain’ accompanied by a multitude of methods to assess and manage it. Intervene notes that pain management and recording varies hugely between organisations, depending on culture, management’s expectations and demands, and staff experience and attitude. 

It is not just a person’s dementia alone that needs to be considered when assessing pain. Factors like background, circumstance and generational differences may all play a part too. 

Intervene highlights the importance of being aware that the perception of pain can be exacerbated in aged care facilities due to the change of environment, unfamiliarity and the feeling of loss of control. Importantly, perception of pain intensity can be reduced when staff who are close to the individual provide a comforting presence, as can touch and empathetic language.

Effective pain management requires a holistic person-focused approach, there is not a one-size fits all method. What positively impacts one person’s pain may not be appropriate or accurate for someone else. Proper assessment of the cause, severity and impact of pain is vital when figuring out the most appropriate way to relieve it.

If pain is expressed as responsive behaviour it may well result in increased medication and inappropriate use of antipsychotic drugs—not necessarily aiding its underlying causes. Additionally this ‘demanding’ behaviour may result in the person becoming unpopular with staff in the residence, impacting perception and reaction to the expression of pain. McClean and Cunningham state that a significant and predictable time for responsive pain behaviours is first thing in the morning, when a sore limb is moved. The introduction of pain relief medication before, not after assistance to getting up, can be a simple and important change in care and most importantly to how a person with dementia starts their day!

Current good practice is to give regular doses of pain relief. Steps to assess pain and responsive behaviour should be as simple as possible and not restricted to prescriptions—treatments like physio and occupational therapy have been proven to be highly beneficial as well.

Find out more

To discover more innovative thinking and evidence proven in practice have a look at our specialised workshops that explore the issues of pain assessment and how to support those whose lives are impacted by pain. 

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Margaret Nowak
With the increase in dementia residents with major behaviours I am having trouble explaing to other RN's the need for pain amnagemnt. i am sure this info will help