Care Partner Information Sheet

Dementia - Assessing Pain

People with dementia can experience pain, just like anyone else. But, they often react to pain differently than others. There are several reasons for this. One is that people with advanced dementia aren't able to tell you they hurt. Or, they might feel bad, but don't understand what they are feeling. So, you can't count on them to tell someone if they hurt, or what hurts.

Pain in Early Dementia

In the early stages of dementia, you can usually just ask the person and they will tell you what hurts. You often can ask them to tell you how bad it hurts by using the smiley faces scale shown below.

Pain in More Advanced Dementia

As dementia gets worse, you will need to use different ways to find out if they are having pain. You will need to watch them and listen to them. Signs of pain include crying, moaning, or yelling for no reason, or being "difficult." People's faces may also look pained, like frowning or clenching their teeth. Or they might just roll around in bed and moan. Any of those things can be a sign that a person is having pain.

How to Tell if a Person With Dementia is Having Pain

The table below lists things or "signs" that can be used to tell if a person with dementia is having pain, but you must watch the person's behavior. The staff in nursing homes and hospitals use these signs all the time. You can also use them at home or anywhere else.

Signs of Pain in People with Advanced Dementia
Behavior What to Look For
Breathing
If breathing is heavy or noisy, it is more likely that pain is present.
Whimpering, Moaning or Crying
The louder and more often there is whimpering, moaning, or crying, the more likely the person has severe pain.
Facial expression
A sad or frowning face can mean mild pain. Clenched teeth, eyes squeezed shut, or twisted mouth often means severe pain.
Body language
People with severe pain will often be rigid, with fists clenched and knees pulled up. They may also lay in bed rocking. Or, they may push or hit people.
Comforting
Can you comfort the person to make them feel better? If not, it's more likely that they are having pain.
Eating
Sometimes people in pain, especially stomach pain, refuse to eat.

Some info in this table is from Warden, 2003 and Abbey, 2004.

You can use the behaviors in the table above to help decide if someone has pain. You can also use it after giving someone medicine to treat pain. If the pain behaviors get better after taking pain medicine, the pain is probably getting better.

Finally, if you are providing care for someone and they frequently show the behaviors above, you should tell the doctor or nurse who provides their medical care.
 

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Written by: Barry D Weiss, MD, University of Arizona College of Medicine