NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update Acute

Dementia and Pain Management (October 2014)

Information below is specific to the use of medicines in the adult setting.

 

One in four general hospital beds in the UK are occupied by patients over 65 years who have dementia.  Almost all staff groups will interact with patients with dementia and must be aware of the needs of this patient group and the impact that an admission to hospital may have on them (to learn more, access the  LearnPro module). 

 

As dementia progresses the patient’s ability to express thoughts, feelings and needs can reduce, until the only way to communicate and express their self is by behaviour.  Pain is a common cause of distressed behaviour in a patient with dementia and studies have shown the following:

 

  • A systematic approach to pain management can significantly reduced agitation and aggression in nursing home residents with moderate/severe dementia.
  • Post operatively, patients with dementia received one third of the pain relief offered to cognitively intact adults who could express their pain.

KEY MESSAGES FOR PAIN MANAGEMENT

  • Determine if the patient’s past medical history includes persistent pain.
  • Ensure that Medicines Reconciliation has been completed and includes the patient’s analgesic history.
  • Ensure that an appropriate pain assessment has been undertaken.  The PACSLAC tool can be used to assess pain in patients with limited ability to communicate.
  • Consult the Therapeutics Handbook for advice on the choice of analgesic; consider also the adverse effect profile of the analgesic e.g. confusion, drowsiness, constipation.
  • Prescribe ‘regular’ rather than PRN analgesia.
  • Consider liquid or patch formulations if the patient has difficulty swallowing tablets.
  • Regularly assess and review the pain management plan.

REMEMBER

 

  • Patients with dementia may not be able to identify or describe pain.
  • Behavioural changes in patients with dementia could be due to pain.