Diagnosing Pain in Alzheimer's Patients

When most adults feel pain, they know they can go to a physician and explain their distress in words. Something as simple as "My Stomach!" at least gives the doctor some idea about what his patient is feeling. Older adults with cognitive impairment due to diseases such as Alzheimer's disease often do not have the same ability to express what they are feeling. Treating pain in Alzheimer's patients, therefore, becomes much more difficult. Even diagnosing the presence of pain in patients becomes, sadly, more prone to error. For example, some studies show that accuracy in diagnosing pain decreases as impairment increases, leaving doctors scratching their head for a solution to their dilemma.

Older adults with dementia face the same aches and pains associated with aging as healthy older adults, yet they are less likely to receive treatment for their pain. Typical scales used to assess pain rely on verbal responses and cognitive ability, causing patients with the most severe type of Alzheimer's disease to be the most vulnerable to misdiagnosis. Lack of verbal ability has led doctors to seek other diagnostic tools for their patients with dementia. Treating pain in Alzheimer's patients is like treating pain in a child, some say. Doctors, therefore, must rely on facial expressions as clues to the nature of their patients' distress. In the most severe cases, however, even facial expressions are not good indicators. Patients in the last stages of Alzheimer's disease lose the ability to smile or make other facial expression. As a result, doctors must be particularly vigilant in observing nonverbal behavior in their patients with Alzheimer's, and they must seek information and advice from caregivers about their patients' behavior and medical history. Caregivers may want to seek the services of a physician trained in treating patients with dementia, particularly if they feel their current physician is not skilled at working with patients with cognitive impairment.

Treating pain in Alzheimer's patients may be difficult, but caregivers can help doctors considerably if they are made aware of the nonverbal signs and behaviors associated with pain. For patients with less severe Alzheimer's, caregivers should carefully study facial expressions. Some say the eyes are windows to the soul, and when they are narrowed or shut, they can indicate pain. Verbalizations, such as screaming, labored breathing, or even speaking abusively, are other obvious signs of discomfort or pain. Pain also affects the way people move their bodies, causing either rigid, slow movements or tight, rapid movements like finger tapping. Changes in mood and behavior are typical signs of the progression of Alzheimer's disease, but they can also be the result of pain. For example, distress and its accompanying behaviors, such as crying and being disoriented, could be caused by pain. Bad behaviors like aggressiveness, non-compliance and isolation may be pain-related. Finally, changes in routine behaviors like sleeping poorly or excessively or refusing to eat can be indicators of pain. Treating pain in Alzheimer's patients first requires a diagnosis, and by simply being aware of pain behaviors, caregivers can be the first line of defense against physician errors.

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