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Dementia and Pain

“People with dementia don’t feel pain.”

Bullsh*t. Which is how I should have responded 34 years ago when I was a nursing student caring for a person with dementia in a nursing home. My patient had a foot ulcer and the physician decided to remove the top layer of the ulcer so that the wound would heal. The physician whipped out a scalpel and proceeded to cut out the top layer of the ulcer on the man’s heel. I was floored. “What about giving him something for pain?” I queried, horrified at what I was seeing. The physician shook his head and blurted out, “People with dementia don’t feel pain.”

People with dementia DO feel pain: physical, psychological, emotional. They may not be able to TELL me in words about the pain. They can tell me through their actions.

Straight up, if persons with dementia look like they are in pain, they probably are. Period. There are outdated beliefs, such as people with dementia are less sensitive to pain, but that is utter nonsense. Also, this article does a nice job of discussing pain management in persons with dementia.

There is a table with behaviors that convey pain.

This other site is a pdf written by a physician from UNC – Pain Management in Dementia.

First of all, a person with dementia may not be able to say, “I hurt,” the way you or I would.

But they can communicate “I hurt”

  • through fidgeting,
  • crying,
  • moaning,
  • holding the affected area,
  • rubbing the affected area,
  • becoming rigid or restricting their own movements,
  • and showing agitation (pushing the caregiver away, yelling, even thrashing).

Once you see that the person with dementia is feeling pain, what next? That topic will be handled in next week’s blog.

Some of this content was previously published on the Alzheimer’s Reading Room, where I often contribute as a blog-author. 


Categories: Alzheimer's Disease Dementia pain Refusal Behavior Understanding Behaviors

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Dr. Rita Jablonski

Rita Jablonski, PhD, CRNP, FAAN, FGSA is a nurse practitioner, researcher, tenured professor, and former family caregiver. Her research and practice involve all aspects of dementia management; she is best known for non-drug strategies to address dementia-related behaviors.

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