Pain: An unpleasant sensory and emotional experience associated with actual or potential tissue damage (IASP, 1994).
Acute pain: Has a distinct onset, obvious pathology, and short duration.
- Common types of acute pain are post-surgical, headache, or acute injury or illness.
- Pain in Patients with Dementia:
- Older adults with dementia may not be able to report/localize acute pain.
- Acute pain may be due to such things as undetected fractures and injuries, positioning, urinary retention, constipation/fecal impaction.
- Assume patients with dementia have pain if they have conditions or are receiving procedures that typically cause pain and administer analgesics as appropriate.
- Untreated pain in individuals with dementia can disrupt sleep and activity patterns, impair function, and quality of life.
- Older adults may be reluctant to report pain or pain may present atypically. Observe for changes in behavior, including withdrawal, change in activity level, sleeping problems, or agitation.
- Assume patients with dementia have pain if they have conditions or are receiving procedures that typically cause pain and medicate.
- Assess present pain, including intensity, character, frequency, pattern, location, duration, and precipitating and relieving factors. Assume patient's report is the most reliable indicator of pain.
- Use a standardized tool to assess self-reported pain. Use a simple tool Try This: Pain Assessment in Older Adults.
- Observe for nonverbal and behavioral signs of pain, such as facial grimacing, withdrawal, guarding, rubbing, limping, shifting of position, aggression, depression, moaning, and crying. Also watch for changes in behavior from patient's usual patterns.
- Review medical history, physical examinations, and laboratory and diagnostic tests in order to understand the sequence of events contributing to pain.
- Gather information from family members about patient's pain experiences. Ask about patient's verbal and nonverbal/behavioral expressions of pain, particularly in persons with dementia.
- Review medications, including current and previously used prescription drugs, over-the-counter drugs, and home remedies. Determine what pain control methods have previously been effective for the patient.
- Assess pain regularly and frequently, but at least every 4 hours. Monitor pain intensity after giving medications to evaluate effectiveness.
Care Strategies/Pain Medications
Administer pain medications on a regular basis to maintain therapeutic levels; avoid prn drugs. Use acetaminophen or opioids. Avoid meperidine.
- Older adults are at increased risk for adverse drug reactions and drug--drug interactions. Monitor medications closely.
- For severe pain, consider patient-controlled analgesic pump in cognitively intact elders.
- Consider use of non-pharmacological pain relief strategies, such as heat, cold, relaxation, or transcutaneous electrical nerve stimulation (TENS) units.
- See choices of pain medications, side effects, and medications to avoid in Medication section
Common Side Effects
- Monitor for constipation, sedation, delirium, urinary retention, respiratory depression, and nausea.
- With long-term NSAID use, monitor for GI bleeding, renal insufficiency, and other drug interactions.
Merskey H, Bogduk N. (Eds). (1994). Classification of Chronic Pain, 2nd ed. Seattle: International Association for the Study of Pain Press, pp xi-xv.
Reprinted with Permission from Springer Publishing Company. Horgas, AL & McLennon, SM.( 2003). Pain management In Mezey, M, Fulmer T, Abraham I, (editors); Zwicker, D, (managing editor). Geriatric Nursing Protocols for Best Practice. 2nd ed. New York (NY): Springer Publishing Company, Inc.; p. 229-50.
Last updated - February 2005