The physical needs of people with dementia often get missed, not noticed or even mistaken for behaviours that are inappropriate, behaviours that often will be classed as challenging. But who is it challenging to, the staff, the family, and the visitor. No the person themselves. Often unable to understand what the pain is or unable to communicate that they are in pain. The service user in the corner banging their head against the wall because they have a headache is often seen as self harming, disruptive, challenging instead of the recognition and understanding from staff as to why it is happening. NICE Guidelines (2006) states “If a person with dementia has unexplained changes in behaviour and/or shows signs of distress, health and social care professionals should assess whether the person is in pain, using an observational pain assessment tool if helpful.” However, the possibility of other causes should be considered. Often confused the service user loses respect and dignity from staff by the way the staff deal with the situation, assuming because of the service users condition or confusion they cannot or will not complain. We often misdiagnose pain when it is considered that the service user is exhibiting behaviours that challenge, which if the reason is pain will not help the service user. Ways in which staff can recognise pain in someone with Dementia is. Talk to the person direct and ask questions, some service users no matter at what stage their memory is at, having short term memory will only tell the service user the pain exists at that moment, but never the less it is still reality to them. Getting to know the service user from the first moment they arrive into the home can only establish an understanding of their daily routine, which will show any differences in their behaviour. Behaviour such as vocalisations (or making sounds): whimpering, groaning, crying facial expressions: looking tense, frowning, grimacing, looking frightened changes in body language: fidgeting, rocking, guarding part of body, withdrawn behavioural changes: increased confusion, refusing to eat, alteration in usual patterns bodily changes: raised temperature, pulse rate or blood pressure, perspiring, flushing or looking very pale Make note of changes in the person and explore their behaviours to determine if pain is their concern, the use of pain assessment tools will also help determine the cause of the pain, its severity, when it occurs and what helps to make the pain better or worse. This leads to a lot of distress and behaviour.