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Assessing Pain in the Cognitively Impaired
U.S. Pharmacist, 05/22/09

Zagaria MAE - It can be difficult for a spouse or adult child to become a caregiver for their family member when the patient is experiencing pain associated with a surgical procedure, acute trauma, or conditions that are chronic or terminal. Pharmacists may help caregivers feel empowered to provide appropriate care by educating them on the use of pain scales and observational clues for the assessment of pain in seniors.

• Assess for pain behaviors during movement.
• If noted, consider 1) premedicating the patient before any movement, 2) strategies to decrease pain, and 3) reassurance while continuing to observe for pain-indicating behaviors.
• If no pain behaviors are noted during movement yet the patient exhibits other behaviors that may be indicative of pain, then assessment for basic comfort measures (e.g., toileting, thirst, hunger) or underlying disorders (e.g., constipation, depression, infection) should be performed.
• Finally, provide treatment for the identified cause or consider a trial of empiric analgesic therapy. Reduced pain behaviors have been associated with initiated analgesic therapy with acetaminophen 500 to 1,000 mg three times a day. Timing of a pain assessment should be at the peak of medication effectiveness; the use of a more potent dose or agent may be necessary to relieve more severe pain and alterations in behavior, since pain cannot be quantified in terms of intensity in patients with severe dementia.

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