Understanding Pain in Cognitive Decline: Treatment Tips for Caregivers

Dealing with Cognitive Decline

Aging is a natural process, and it brings with it various physical and cognitive changes. One area of growing concern in healthcare is the intersection between age-related cognitive decline and chronic pain management. As people age, the likelihood of experiencing cognitive decline and chronic pain increases, which can challenge both the individuals and their caregivers. Not only do these conditions impact everyday life, but they can also affect the lifestyle adjustments and care options necessary to maintain quality of life.

Understanding Age-Related Cognitive Decline and Its Link to Chronic Pain

Some decline in cognitive function is normal with aging, but age-related cognitive decline refers to significant challenges with thinking, memory, focus, problem-solving, and other higher brain functions. This decline can range from mild cognitive impairment (MCI) to more severe conditions such as dementia.

Symptoms of age-related cognitive decline include:

Consistent forgetfulness, even of important events
Losing one’s train of thought frequently
Feeling overwhelmed by decision-making or planning
Getting lost in familiar areas
Poor judgment and lack of self-control

Research indicates a link between age-related cognitive decline and chronic pain, particularly in individuals with dementia, including Alzheimer’s disease. For instance, both chronic pain and Alzheimer’s disease affect an area of the brain called the locus coeruleus, which manages the release of norepinephrine, a chemical messenger. Damage to this area can result in an excess release of norepinephrine, leading to inflammation of pain-relaying cells in the brain, thus increasing pain sensitivity.

In addition, chronic pain often results from previous injuries or major surgeries. As cognitive decline limits mobility, affected areas may become stiff and sore. If patients avoid using certain body parts or resist repositioning due to discomfort, muscles and tendons may tighten, and pressure ulcers can develop, further exacerbating pain.

How to Assess Pain in Patients with Age-Related Cognitive Decline

Individuals experiencing cognitive decline may not express pain as they once could. They may lose the ability to verbally communicate pain or even show it through nonverbal cues like facial expressions. When a person cannot effectively communicate pain, it’s essential to look for alternative signs, including:

Abnormal breathing patterns
Negative vocalizations, such as groaning or crying
Distressed facial expressions, such as frowning or grimacing
Tense or rigid body language
Increased aggressive behaviors like shouting or striking out
Repeatedly needing to be consoled or an inability to be consoled

The Pain Assessment in Advanced Dementia (PAINAD) scale was developed to help caregivers and healthcare providers assess pain in individuals with cognitive decline. This tool assigns points to different pain indicators based on their severity, providing a better understanding of the patient’s pain level and ensuring it doesn’t go untreated.

Conservative Treatment Options for Chronic Pain in Individuals with Cognitive Decline

Various conservative treatments can help alleviate chronic pain for individuals experiencing cognitive decline. Some effective methods include:

Medication: Pain-relieving medication can be effective, particularly when patients can communicate their pain. For instance, a doctor might prescribe an anti-inflammatory drug to target pain caused by inflammation.
Massage: Gentle massage by a therapist or caregiver can be beneficial. Observing the patient’s body language—such as signs of relaxation or slower breathing—can help gauge whether the massage is easing their pain.
Music Therapy: Familiar music can distract patients from pain and may trigger the release of endorphins, the body’s natural pain relievers. Music can also reduce stress, as it often brings back happy memories and positive emotions.
Repositioning: Regular repositioning can be particularly helpful for patients who may not communicate discomfort from prolonged positions. Changing positions can ease pain, improve blood flow, and prevent pressure sores.

Care Beyond Caregivers

Managing chronic pain in individuals with age-related cognitive decline requires patience and close attention to both verbal and nonverbal cues. Caregivers play an essential role in identifying signs of pain and implementing techniques to soothe it. At Ospina Medical, we prioritize compassionate, individualized care for all our patients. Dr. Kohler and our experienced team are dedicated to observing and managing these subtle signs of pain, and helping those with cognitive decline experience improved comfort and quality of life. For those seeking a comprehensive approach to managing pain for a loved one, we invite you to schedule a consultation today to help us help you.

Written By: Sudheshna Mageshkumar

Edited By: Camden Rowe

Medically Reviewed By: Matthew Kohler, MD