Pain in the Cognitively Impaired

You are seeing an elderly man with prostate cancer and cognitive dysfunction. His daughter is
concerned that he may be experiencing pain. Which of the following statements is true regarding pain management in a cognitively impaired patient.

a. Family members tend to under estimate the degree of pain in cognately impaired loved ones.
b. Opioids tend to worsen behavioral problems due to disinhibition.
c. Patients with Alzheimer’s dementia lose the ability to perceive discomfort.
d. The best indicator of pain is often a change in behavior.

Answer: d.

In the cognitively impaired, a change in behavior is the gold standard indicator that
something is wrong, including a possible painful condition. A change in behavior can mean
anything: a urinary tract infection, worsening arthritis, fractured bone, mouth sore, skin rash, etc. The key is to be aware that behavioral change may be indicative of a painful condition, warranting a through physical assessment. Common behavioral changes in this population include changes in ambulation, speech, food intake, and social interactions. Some clinicians advocate a trial of an analgesic even if no specific painful condition is found.

Fast Fact #89 Analgesic Tips in Nursing Homes