Pain Management for Persons with Late-Stage Dementia

People with dementia have often been excluded from medical studies focused on pain and pain management, but there is evidence that they experience frequent pain, which is often poorly assessed and under-treated. A new treatment plan (called a protocol) has been developed for assessing and appropriately treating pain in patients with late-stage dementia, who typically have difficulty communicating verbally.

Medical College of Wisconsin researcher David Weissman,MD, Professor of Medicine, and his colleagues, Julie Griffie, RN, Nurse Specialist, and Sandy Muchka, RN, Nurse Specialist helped develop and test the Assessment of Discomfort in Dementia (ADD) Protocol.

The ADD program is designed to help physicians and caregivers:

More accurately assess discomfort in people with dementia who can no longer verbally describe physical pain or emotional discomfort.

More accurately and thoroughly treat physical pain or emotional discomfort

Decrease the inappropriate use of psychotropic medication

Common signs displayed by people with late-stage dementia who experience physical or emotional discomfort include: increased agitation, fideting, or repetitive movements: tense muscles, body bracing; increased calling out or repetitive verbalizations; decreased cognition; decreased functional ability or withdrawal; changes in sleep pattern; falling; increase in pulse, blood pressure and sweating. A good deal of emotional discomfort in dementia patients comes from difficulty sorting out and negotiating everyday life activities.

The ADD Protocol:

1) Physical causes for discomfort such as inflammation, infection, acute illness, chronic conditions, etc. were assessed first.

2) As part of the physical assessment, the patient's physical history was explored including a consultation with the family regarding potential causes of pain.

3) If the physical assessment was negative and there was no apparent reason for discomfort, then nonpharmacological comfort interventions were used. These included soothing and supportive verbal communication, soothing and supportive touch, physical exercise and movement, and sensory stimulation including music therapy and therapeutic massage.

4) If the nonpharmacological interventions were unsuccessful in relieving the patient's discomfort, then the staff administered a non-narcotic analgesic, such as 500 milligrams of acetaminophen (e.g. Tylenol)

5) If there was not a response to trying an "as needed" analgesic, then a stronger analgesic or, sometimes, a psychotropic drug was prescribed.

Results of the study indicate that the stages of assessment and treatment set forth in the ADD protocol did help to reduce the frequency of discomfort symptoms expressed by the patients. In the 7 days before the study, the patients displayed an average of 33 behavioral symptoms associated with discomfort. In the period following use of the ADD protocol, this was reduced to 23 behaviors - a statistically significant improvement.

The results of this pilot project demonstrate that the needs of this group can be recognized and treated. But the authors of the study stress that further improvement in palliative care services are needed for the silent but growing population of people with late stage dementia.

For more information about the Care and Services offered by Elderwood Senior Care, please contact us at (716) 633-3900.