Community Blog

Signs of Pain

By Bonnie Roberts

"Imagine your brain as a house filled with lights. Now imagine someone turning off the lights one by one. That's what Alzheimer's Disease does. It turns off the lights so that the flow of ideas, emotions, and memories from one room to the next slows and eventually ceases. And sadly, - as anyone who has ever watched a parent, a sibling, a spouse succomb to the speading darkness knows - there is no way to stop the lights from turning off, no way to switch them back on once they've grown dim. At least not yet." 

~ Excerpt from "The Science of Alzheimer's", J. Madeleine Nash, "Time", July 17, 2000

Wednesday I attended a workshop on providing hospice care to those with end stage Alzheimer's or related dementias. The workshop was given by Compassionate Care Hospice at The Arbors of Bedford.  While the workshop covered some basics like the different types of dementia (remember, all Alzheimer's is dementia but not all dementia is Alzheimer's), one particular part of the workshop stood out and I thought I'd share it with you: pain assessment in those with Alzheimer's or dementia.

As many of you know from experience, those with dementia, brain injury, stroke, aphasia, or any number of other medical conditions may have significant difficulty with language and communication. Some may be completely non-verbal while others may have trouble finding words and not be able to effectively communicate their basic needs. This is when knowing your loved one and your ability to read their body language becomes a critical key to providing outstanding care.

One Sunday not too long ago a caregiver called me because she was having a hard time with her client. He was fighting her at every turn, showing extreme agitation and generally being quite difficult. Now this client has a history of being a bit difficult and he isn't always able to communicate effectively, but this day his behavior was way out of normal range so the caregiver was understandably concerned. Come to find out, he had pneumonia. He was hospitalized that day and is now in rehab.  

So, what are some non-specific signs and symptoms suggesting the presence of pain in those who cannot tell you outright?

  • Frowning, grimacing, fearful, facial expressions, grinding of teeth
  • Bracing, guarding, rubbing
  • Fidgeting, restlessness
  • Striking out, increasing or recurring agitation
  • Eating or sleeping poorly
  • Sighing, groaning, crying, heavy breathing
  • Decreasing activity levels
  • Resisting certain movements during care
  • Change in gait or behavior
  • Loss of function
  • Increased sleeping

Again, it's important that we pay attention to the details of our loved one’s behavior and note any changes. If they always fidget, fidgeting may not be a sign that suggests pain, but if there is increased fidgeting and one or more of the other signs or symptoms, they may be trying to convey that they are hurting.  

If you have any questions or need assistance with your loved one, please feel free to give me a shout.

Bonnie Roberts
Home Helpers of Londonderry