Dementia and pain, or lack of it

[sammyb]

I have been reading through a number of posts and am intrigued by people saying their loved ones with dementia appear to have changed perception of pain, or changes in their previous allergic reaction to things. I am still in shock or wonder (I don't know which) that my laddo appeared to be in no pain whatsoever when he died of cancer - despite it being so aggressive. How can that be? Is dementia capable of knocking out pain receptors?

Love from Sammyb

 

[Grannie G]

Hello Sammy

I can`t answer your question, but when my husband fell, in the early stages of dementia, he was examined quite roughly and undressed without special treatment, but it was only when the Xray was inspected, the doctor realized he had a broken arm.
The doctor apologized to my husband but he didn`t find it important at all.
And while it was healing he used it far more than I would have thought possible.

 

[noelphobic]

My mum fell out of bed a couple of years ago. She was taken to hospital as a precaution but seemed perfectly OK and definitely not in any pain. However, when she was x-rayed it transpired that her collar bone was broken! The hospital staff were amazed that she wasn't in any discomfort whatsoever.

It was a different story when she broke her hip however, as she was in a great deal of pain then.

 

[Mameeskye]

I know that the nurses in Mum's home told me that sometimes it seemed like a blessing as often the brain just did not register pain in the way we were used to feeling it. But they said that they had to be cautious as an itch or restlessness could indicate a problem even when there was no pain. Suppose if it stops you talking, moving etc. it must also affect the nervous sensation of pain too.

I know that throughout her final days my Mum gave no indication of being in pain at all, a blessing indeed.

Mameeskye

 

[connie]

My dear Lionel has always had a low pain threashold.

This has not changed, even now that he is 'end stage' dementia.
The care staff are always so gentle with him because of this.
Even so he cries out in pain when they try to straighten his legs from the foetal position. Heartbreaking.

 

[Skye]

Hi Sammy

I believe that dementia affects pain receptors differently in different people -- when you've seen one........!

All the time John had a huge sore on his heel, I only saw him show signs of pain on a couple of occasions. But there's a lady in the unit who screams the place down every time they try to take her to the toilet.

Also, there's the fact that some people with cancer have no pain. My nephew died of cancer of the oesophagus last year, and he was completely pain free.

 

[citybythesea]

I am like Hazel, it is different in every one. Mom had pain when we did the thereapy to keep her arms and legs straight, but once they were straight she had no pain. I think its all in what is perceived.

I can say some cancers aren't painful. I can name 2 off the top of my head. The surgury recovery was painful. Some of the treatments were painful, but not the cancer itself.

It's all in what that one person can handle and in what the actual circumstances are.


HUgs

Nancy

 

[SkiTTish]

Its funny you should post this as I was discussing this very matter with mums specialist .
Mum used to suffer terribly with athritis , she needed regular steroid injections and home adaptions to help her to move around
Only as the dementia worsened the symptoms of the arthritus lessened and now she has no symptoms atall
The specialist mentioned it is rather common to hear this happening
Hey ,in such a bloody awful disease atleast there there is one plus

 

[CraigC]

Hi Sammy,

I remember reading something about pain thresholds and dementia but for the life of me can't find the link. It was all about the perception of pain for people with dementia. It is often hard to tell when dad is in pain or how to identify the location of pain - I know it must be incredibly frustrating for him thats all.

When you are in pain you are often asked to guage the pain on a scale of 1 - 10. If you are in severe pain it feels like the daftest question anyone could ask you, but it does give them a good guage to help with diagnosis. Dad like many with dementia would be incapable of responding to this type of question and it makes things incredibly difficult when he is unwell.

I did find this one link when hunting:

http://www.bmj.com/cgi/content/full/330/7489/461

A key question relates to whether and how patients with dementia perceive pain. Patients with dementia may express their pain in ways that are quite different from those of elderly people without dementia.3 Particularly in the more severe stages of dementia, therefore, the complexity and consequent (frequent) inadequacy of pain assessment leads to the undertreatment of pain.

As Hazel says, everyone with dementia seems different so that is why it is hard to find any definitive research.

I'll keep hunting for the original article as I think it was published in one of the societies magazines.

Kind Regards
Craig

 

[Margarita]

I find my mother will scream her head of when she sees the scissors to Cut her nails, even thought when cutting them they do not hurt her.

Yes I read it also that even thought the pain is there, they can't express it to say where the pain is coming from .

Like even thought my mother has arthritis in her knees, she can't tell me for unknown reason that its hurting her, like she did in the past . So will carry on walking like there nothing wrong .

She use to squint her eyes very tightly of on for a long time , when I ask her why she doing that she touch the side of her leg saying my leg hurts me , Now she does not squint her eyes or tell me her leg hurts her , but still walking with Zimmer frame

Then the other week When the nurse injected a the needle into a Vain in her hand , My mother screamed blue murder .

I am still in shock or wonder (I don't know which) that my laddo appeared to be in no pain whatsoever when he died of cancer - despite it being so aggressive.

Was your husband not taking any morphine for the pain ?

 

[sammyb]

So very strange isn't it? Stranger still that laddo would have been able to communicate with me if he had been in pain. So I am pretty sure he wasn't - not from the cancer. However, just brush past his bare feet and he would be yelping. No rhyme or reason is there?

Love from Sammyb

 

[Margarita]

Dementia and pain

Read this

http://www.pssru.ac.uk/pdf/MCpdfs/Pain_factsheet.pdf

 

[CraigC]

What a brilliant find Margarita!
Have printed the sheet off to take to dads care home today! The section on pain observation for people with dementia is particularly useful.

many thanks
Craig

 

[Brucie]

Yes I agree, a great link from Margarita.

I have copied it to a thread of its own in Resources, and made it Sticky.

Such an important topic!

I'm taking a copy to Jan's home too.

 

[Margarita]

Good idea about putting it as a sticky & printing it out for care home, I really must sort my printer out.

 

[dina384]

no pain

Dementia can mask pain i know tht from my dads experience and also i work with Dementia patients

 

[SkiTTish]

Whilst I believe inability to vocalise the feeing of pain can be the case in some people and I dont think thats the only reason
Mums Arthritis caused swelling and inflamation all of which have gone now
She also can still complain of pain and regularly has lil aches and pain .tummy pains ect bUT all signs of chronic pain and even the physical manifestations have gone

 

[Skye]

It is important to realise that dementia does not alter the fundamental experience of pain.

I'm afraid I disagree with this too.

John had a sore on his heel two inches in diameter and half an inch deep. It took eight months to heal, and was repeatedly infected with MRSA.

He was on no medication, but in all that time I only saw signs of pain (he cannot verbalise) on two or three occasions. I asked for painkillers for him, and they were administered.

I agree that it is sometimes easy to miss the signs of pain if the carer is not vigilant, but I really don't think John would have been in pain for eight months without my noticing it.

The article makes valid points, but I have to challenge the writer on that.

 

[BeckyJan]

Hello:
I cannot really make sense of this thread, although I think it is great and good for thought.
My David who I think is in stage 6 ish of this wretched disease, is suffering immense pain!! I am not sure what it is all about. He has pain in his bottom and legs. Every possible cause has been investigated. He is on painkillers but nothing stops this awful pain Even the am carer winces with him

This is the new man, not the one pre dementia whose pain threshold seemed normal. I feel he needs morphine patches but our medics are not keen.

It seems we are opposite to other dementia sufferers.

I know this does not help anyone but felt it should be recorded in case there are others in a simmilar situation.

Love Jan

 

[Grannie G]

When my mother had shingles, and no means of communication, there was a tortured expression on her face. But we are not sure whether it was from the pain of shingles or the fear of being in a strange place when she was hospitalized.