4.4 Pain

Pain is a common sign of severe dementia and lasts the entire course of the disease for many patients. Up to 63% of dementia patients experience pain. The causes of discomfort are similar among older adults and the frail, such as infections, arthritis, and constipation.
Pain may have an impact on other symptoms at the end of life. For example, pain and depression were linked, and those who experienced less pain had lower depression scores.
Moreover, pain is linked to behavioral and mental problems. The presence of pain or discomfort not being appropriately treated in dementia patients might be indicated by symptoms like depression, agitation, and challenging behavior.

How to Measure Pain
Due to the lack of communicative skills that typically occurs during the condition, dementia’s symptomology also makes it difficult to measure pain. As a result, frequently used evaluation tools lack validity and reliability.
To make matters worse, educational and administrative deficiencies in dementia care facilities often impair the standard of care and treatment, including pain management.
Pain Treatment
The evidence supporting the difficulties of pain treatment in dementia is discussed in the Model for Pain Relief developed by the WHO. The model concentrates on four critical viewpoints that are crucial to this topic.

1. Biological Perspective – This is the first step in the model. Focus is placed on the effect and consequences of neuropathological changes in dementia on pain.
2. Assessment Perspective – It focuses on the challenges of pain assessment in dementia.
3. Organizational and Educational – It pays attention to aspects that challenge pain management in dementia.
4. Pain Management – It is performed on the ground. “Pain teams” and chances for employees to consult with experts in all dementia care settings are potentially helpful for patients’ pain management.