As many as 80% of long-term care residents suffer from pain. And yet this pain is underrecognized and undertreated, at least in part, because people with moderate to severe dementia may not be able to tell us about their pain. Everyone knows that it is difficult for us to communicate to others exactly how we feel when we are in a lot of pain. Imagine how much harder this becomes for those who cannot describe their pain at all because of the deterioration of verbal and other communicative abilities that accompanies dementia.
Over the years we have heard stories of serious problems such as fractures that can go undetected for days and even longer with people suffering in isolation. Regular long-term care pain assessment, using validated and objective methods such as the PACSLAC-II, can lead to earlier recognition of health problems so that these can be treated before they become more severe. Better pain care can improve quality of life for the residents. Our research also suggests that regular pain assessment can lead to improved pain management and even reduce unnecessary medication use.
One of the most interesting findings of our research was that not only is frequent pain assessment good for the patients, but it can also lead to reductions in work stress/burnout among nursing staff who conducted regular pain assessments as compared do those who did not. This may have occurred because better pain assessment/management may be leading to reductions in challenging behaviours in long-term care which would improve the quality of interactions between staff and residents. It is also possible that pain assessment reduces the uncertainty that staff may experience in regards to the most appropriate intervention for a patient; reduced uncertainty leads to reduced stress.
Given that a routine screening pain assessment will typically require less than 5 minutes to complete, we have found that such can be accommodated with good coordination and implementation plans. Extra resources may not even be required when staff and management are willing to work together on improving pain care. Rather than leaving it up to individual clinicians, a coordinated effort with input from both staff members and facility administrators would often be necessary for effective and fully supported facility-wide change.
By Thomas Hadjistavropoulos, Ph.D., FCAHS
How You Can Help?
Would you like to share your thoughts on our See Pain More Clearly initiative and the use of social media to mobilize knowledge about pain in dementia?
We are looking for health care professionals and others to participate in a study to evaluate the effectiveness of the #seepainmoreclearly social media initiative to mobilize knowledge about pain in dementia.
Dr. Thomas Hadjistavropoulos- See Pain More Clearly Team Dr. Hadjistavropoulos is an international leader in the area of pain assessment in dementia and has shown leadership in the promotion of the health sciences at the local, national and international level. He is the Research Chair in Aging and Health, Director of the Centre on Aging and Health and Professor of Psychology at the University of Regina, Saskatchewan, Canada. He served as the 2007 President of the Canadian Psychological Association (CPA).