From Hospice and Palliative Nurses Association (HPNA)
Patients may not be able to speak or describe their pain in the late stages of dementia, if they have had a stroke or in the late stages of other diseases such as amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease). However, just because they cannot speak does not mean they are not experiencing pain.
Family members may be the first to notice little changes in patient's mood or behavior that may mean the patient has pain.
- Always ask the patient if there is pain or if the patient is hurting anywhere. Patients who are nonverbal or have dementia may still have the ability to answer questions by nodding or with eye movements
- Ask family members and other caregivers if they have noticed any changes in behavior that might indicate the patient is having pain
Patients may display any of the following behaviors
- Sleeping a lot of the time or having difficulty sleeping
- Changes in eating patterns
- Facial expressions such as grimacing, frowning, looking sad, wrinkling of the brow
- Movements such as restlessness, fidgeting, moving slowly, protecting a body part, pacing, rocking back and forth
- Noisy, labored breathing
- Looking scared,worriedor troubled
- Acting tense
- Difficulty concentrating
- Wringing of hands or clenching fists
- Pulling at or touching a body part or area
- Increased confusion, restlessness or agitation
- Any change in the patient's usual behavior, for example a very talkative patient may become quiet or a very quiet patient may become very talkative.
- Moaning or groaning
- Coping with pain by using behaviors such as watching TV, humor, conversation, listening to music and guided imagery
- Utilizing terms such as hurting, aching or generalized pain ("hurt all over")
- Withdrawal from family or friends
People have different coping patterns and may not always look like you think a person with pain should look like.
Always ask if the patient has pain.
BELIEVE THE PATIENT! Remember pain is whatever the person says it is, occurring whenever and wherever the person says it does.