Pain management for patients with dementia in nursing homesFebruary 19 2014
GPs are encouraged to support nursing home staff in delivering better pain assessment and treatment in dementia, by following these Top Tips.
- Refer to the patient’s notes to establish whether a pain assessment has been undertaken and documented. If not, observe the patient for the following potential indicators of pain:
- Facial expressions
- Body movements
- Altered interpersonal interactions
- Changes in activity patterns or routines
- Mental status changes
- Physiological changes
- Prescribe regular analgesia rather than ‘when required’. Consider regular paracetamol first-line for initial and ongoing treatment.
- Adopt a multi-modal approach to pain management. Consider prescribing oral and topical treatments (e.g. oral paracetamol with ibuprofen gel) and consider adjuvant analgesics if appropriate.
- Consider liquids first-line if the patient has difficulty swallowing tablets or compliance issues.
- Always prescribe laxatives with opiates. Monitor constipation and treat early
- Do not prescribe antipsychotics for dementia patients with behavioural symptoms if you suspect that pain is involved. Assess and treat pain using analgesia, and then review effect.
- Consider the morphine equivalence when prescribing analgesic patches.
- Consider non-pharmacological therapies (e.g. TENS, heat pads, massage, aromatherapy) when reviewing pain management.
- Remember the maxim that if a person without dementia has pain from a certain disease, then a person with dementia is likely to have pain too.