Chapter

Pain in patients with cognitive impairment

Duncan Forsyth

in Pain in Older People

Published on behalf of Oxford University Press

ISBN: 9780199212613
Published online May 2011 | e-ISBN: 9780199606924 | DOI: http://dx.doi.org/10.1093/med/9780199212613.003.0003

Series: Oxford Pain Management Library Series Opml P

Pain in patients with cognitive impairment

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• Pain is inadequately recognized and treated, especially in those with severe cognitive impairment. • Poorly treated pain is associated with increased disability, depression, behavioural problems (inappropriate prescription of neuroleptics), and worsening cognitive function. • Barriers to assessment of pain include: declining verbal communication skills with worsening dementia; most pain assessment scales rely upon verbal skills; and the misconception that pain is less severe in those with cognitive impairment. • Better pain assessment should lead to better pain treatment and fewer risks associated with unrelieved pain. • Correct detection, diagnosis and treatment requires appropriate training and properly validated and reliable assessment tools. • A multifaceted approach using a combination of self-reported measures, surrogate pain reporting by family or carers, direct observation of potential pain indicators, monitoring for changes in usual activity and behaviour, and ruling pain out as a possible cause of behaviours through non-drug and analgesic trials, measures of functional impairment/change along with physiological or behavioural measures should improve the accuracy of pain assessment and improve the subsequent management of pain in this vulnerable group of older people.

Chapter.  5806 words.  Illustrated.

Subjects: Geriatric Medicine ; Pain Medicine

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