Dementia and pain, or lack of it

[Helen33]

I've only just caught up with this thread and it has certainly given me food for thought. I have marvelled that Alan has a very high pain threshold (whilst mine is very low). After his hernia op last year they discharged him with two lots of very strong painkillers and Alan didn't need any. His friend had the same op a few months ago and his wife told me he was really suffering with pain.

The only time I remember Alan complaining of pain (and then only slightly) was when he broke a tooth and it needed dental treatment and he had to wait for an appointment.

When he had his cataract op last month, I remember the man in the waiting room saying how painful it was the first day. Alan said he wasn't in any pain.

This is definitely food for thought.

Love

 

[Skye]

It seems we are opposite to other dementia sufferers.

Jan, you're not opposite. Some people are saying their loved ones feel less pain, others that they feel more pain. It's just one more instance where every sufferer is different.

That's why I'm challenging that particular statement in the article. I don't see how anyone can possibly state that dementia does not change perception of pain. Our differing experiences surely prove that that's not so.

Sorry David has such terrible pain, that must be so distressing for you.

Love,

 

[Margarita]

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

hazel read this Its more clinical in the wording of the understanding of it



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

Undertreatment of pain in dementia

In other words, although patients with Alzheimer's disease may still perceive the presence of pain, they may experience its intensity and affective aspects to a lesser extent. Consequently, people with dementia may have difficulty understanding the meaning of the sensation and placing it in context. This could potentially explain the atypical behavioural responses observed in this population (such as frowning or fearful expressions, combativeness, withdrawal, and agitation).

 

[Skye]

Now I think that's a much better article, thank you Maggie.

The first one makes no distinction between different forms of dementia, while this one does.

It seems so obvious to me that experiences of pain will differ according to which area of the brain is affected.

To date, no experimental pain studies have been conducted in other subtypes of dementia, such as vascular dementia and frontotemporal dementia. A recent review of the neuropathology of these disorders indicates that atrophy in the prefrontal cortex in frontotemporal dementia and white matter lesions in vascular dementia, in which areas become disconnected (de-afferentiation), could be responsible for the clinically observed respective decrease and increase in the motivational-affective aspects of pain. The difference in pain experience between subtypes of dementia underscores that studies on pain should not focus solely on the general definitions of "cognitively impaired elderly people" or "elderly people with dementia."

 

[CraigC]

I think they are both good articles, the factsheet is just a lot easier to follow. The BMJ link is the same as the one I orginally posted BTW - don't forget to click on the PDF link to the left of the page to view a more printable version.

Both these links have the makings of a very useful new Alzheimers factsheet ;-)

It seems so obvious to me that experiences of pain will differ according to which area of the brain is affected.

I totally agree with you Hazel, this is one illness where pigeon holes just don't work.

Kind Regards
Cragi