How to understand and manage pain in older people and people with dementia

Pain is a universal experience, yet it is entirely personal. Everyone’s experience of pain is unique, as is their way of describing it. Although pain affects a significant number of older people in care, it is often not recognised or effectively treated.

People with dementia can often find it particularly difficult to describe their pain. For some, pain is described in ways we may not be familiar with, making it even more challenging for carers to understand and manage. Research carried out in 2016 showed that in more than 65% of referrals to Dementia Support Australia, pain had been overlooked or had not been properly managed.

‘Intervene’ is a practical guide for pain care in older people and people with dementia written by Dr William McClean and Associate Professor Colm Cunningham. The book is an essential tool for informing care staff and carers about the different types of pain and pain treatment. It also includes useful examples and practical exercises to help readers put their learning into action.

Understanding pain

So what’s the definition of pain? Many researchers believe pain is a combination of three types of experience: the actual sensation, thoughts about the pain, and emotion. The International Association for the Study of Pain defines it as an ‘unpleasant sensory and emotional experience’ which we associate with tissue damage.

For many, the emotional aspect of pain is just as important as the sensation itself. It’s part of our nature to remember past experiences of pain. In theory, these memories influence how we react to similar sensations and help us avoid pain in future.

In reality, however, they can make the experience more distressing for people with dementia. For example, an older person with dementia may have a long-term memory of childhood pain. When they experience a similar pain in later life, their memory of the childhood pain may resurface and make the experience much more stressful.

When thinking about pain management, it is important to remember that people’s experiences of pain are not only made up of the sensation, but also of the knowledge and emotional response associated with it.

Identifying pain

It is also useful to consider the classification which doctors use to assess pain:

  1. Acute pain: recent onset, generally lasts less than a month
  2. Chronic or persistent non-cancer pain: pain persisting for more than three months
  3. Cancer pain: term used if the suspected cause of pain is a cancerous process

When someone experiences acute pain, a number of physiological changes can be visible. In cases of severe acute pain, like a heart attack, they may become very pale and start sweating.

Chronic pain is often much more difficult to detect. When pain persists for a long time, the body’s acute physiological reactions become ‘worn out’ or blunted. This means that the usual indicators that somebody is in pain – pallor, sweating and other reactions – do not occur. Instead, carers must rely on other indicators. Less frequent socialisation, difficulty sleeping, impaired mobility, or depression can indicate that someone is living with chronic pain. These kinds of non-verbal hints are vital for diagnosing pain and improving care.

Improving pain care

Communication is at the heart of improving pain care for older people and people with dementia. Especially in later stages of dementia, verbal communication can be severely impaired. Non-verbal indicators that someone is in pain can help carers identify when someone is in pain and what kind of pain they are experiencing.

‘Intervene’ sheds a light on these challenges surrounding pain care and offers practical approaches for improving pain management on an individual and organisational level.

You can download or purchase intervene here