Chronic pain and dementia:

Now in my late 70s I live with pain every day – one of the 28 million in Britain according to Lucy Pasha-Robinson who have chronic pain: I’m one of the 28m in Britain who live with chronic pain – where is the plan to help us? | Lucy Pasha-Robinson | The Guardian


Lucy Pasha-Robinson is a relatively young woman and her pain arises from endometriosis which was helped but not eradicated by surgery. Joint pain, especially knee pain is the most common pain, contributing to a life-time prevalence of over 80% and a current prevalence of over 60% amongst people in their 80s Prevalence of arthritis and joint pain in the oldest old: findings from the Newcastle 85+ Study | Age and Ageing | Oxford Academic (oup.com)


The coming together of pain and dementia – both most prevalent in people in later life, makes for a devilish concoction. Both Lucy Pasha-Robinson and NICE draw attention to the limitations and hazards of pain killers and anti-inflammatory drugs. They emphasise the need to come to terms or some sort of relationship with pain as well as the benefits of exercise: Chronic pain sufferers should take exercise, not analgesics, says Nice | National Institute for Health and Care Excellence | The Guardian


Wise council for sure, but what is difficult for the cognitively and emotionally intact is doubly difficult when dementia compromises thinking, reasoning and emotional control.


I have come to know about pain amongst people with dementia in relationship to end of life care – the phenomenon of distress and associated behaviours – sleeplessness, crying, restlessness, shouting out, being resistive to care, to the offer of food or medicines. We have been humbled to recognise that these behaviours are frequently mobilised by pain or its equivalent. Without the words to describe the feelings, we are left to observe and interpret. We have learned that analgesics are useful where tranquillisers are not. Pain, agitation, and behavioural problems in people with dementia admitted to general hospital wards: a longitudinal cohort study - PMC (nih.gov)


So the use of analgesics and anti-inflammatory medication is to be supported for people with dementia. The presence of dementia – reducing the ability to think through the experience of pain, together with reduced emotional control means that it may be justifiable to use relatively higher doses of medication. But all this can be helped by approaches which promote reassurance, encourage mental peace and calm – or counter the distress by pleasure derived from touch, movement and music. All this applies whatever the degree of dementia. Assessment and treatment of pain in people with dementia | Nature Reviews Neurology



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