Pain assessment (usually poor) in dementia

[annie h]

"Barriers to the management of pain in dementia care", Chandler et al, Nursing Times, Vol 110 No. 28, page 12

http://www.nursingtimes.net/Journals/2014/07/09/v/h/g/090714-Barriers-to-the-management-of-pain-in-dementia-care2.pdf

 

[Tex]

Recognising when someone is in pain when they can't communicate verbaly

My sister in law has quite advanced dementia and also Downs Syndrom she is 56 years old and is now double incontinent. She pulls faces and shouts out and I am sure she is in pain. Today I visited her and she said to me as she pushed my hand away "sore " mouth" she had a dentist visit about a month ago and they said all was well. But I am sure she is in pain .I feel upset that nothing is being done. I asked the care assistant to give her some pain relief ,this she did .I telephoned about an hour later and she was much quieter. Does this tell us she was in pain ,I think so. Has anybody gone through this, or is going through this as reading about this issue ,it seems to be a big problem ?

 

[TinaT]

My husband was in pain and dying.
The care home said he was 'OK'.
I said he was in pain and insisted they checked this.
They put in place a pain chart. Day after day the chart said 'No pain', yet when I sat with him I could tell he was in great pain but could not speak about it.
He wasn't eating and was semi concious but the kitchen sent a full meal every day which I returned untouched.

I finally cracked and got a palliative nurse in from the local hospice who transferred him the next morning to the hospice. As I was leaving with him in the ambulance a carer said, "We'll expect you back after his check up".

He died three weeks later after having excellent palliative care for his last few days.

Just my personal experience of how dementia closes carers eyes to what is actually happening. They saw only a deterioration in the dementia, I saw a man in pain and dying.

xxTinaT

 

[maysidotes]

hallucinating pain??

My mother in law who has Alzheimer's has recently been screaming out in pain, especially first thing in the morning when attempting to weight bear. She has been admitted into the local community hospital who put her on heavy duty pain killers which zonked her out but didn't seem to stop the pain. Xrays show some osteoarthritis of the hip and spine but not too severe. However we have just been told that the hospital are taking her off all pain killers and discharging her because they have come to the conclusion that she is hallucinating pain, in other words it is just in her mind and the recommended treatment is distraction. The Social Worker advises that she go into a nursing hone and he said there was no need for a discharge meeting "because we already know that she is a self funder". We said that we want a discharge meeting and that we want the doctor there to help us to better understand the diagnosis. We also questioned with a doctor on duty whether they had carried out sufficient investigations to rule out other potential causes of pain, and they have (rather reluctantly) agreed to a CT scan. My mother in law currently lives with her husband independently. Neither she nor him want her to go into a home. There is a lot of pressure on hospital beds and I am concerned that they just want her out. I fear that things will break down at home if the episodes of pain continue. Has anyone else experienced anything like this?

 

[katlady47q]

Pain

Yes, my husband experiences episodes of intense back pain. This happens when he is upset or delusional. The pain is much more severe than it should be with the amount of arthritis he has and lessens as the delusions pass. He has been put on meds for the arthritis and is having an MRI next week, but I'm not sure this is the answer to the issue of severe pain.

 

[maysidotes]

pain

Yes, my husband experiences episodes of intense back pain. This happens when he is upset or delusional. The pain is much more severe than it should be with the amount of arthritis he has and lessens as the delusions pass. He has been put on meds for the arthritis and is having an MRI next week, but I'm not sure this is the answer to the issue of severe pain.

Thanks katlady, sounds much like my mother in law, please let me know how your husband gets on with arthritis meds (could I ask what) and whether the MRI shows anything. The hospital don't feel that my mother in law would cope with an MRI. But we're waiting for CT results.