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Treating the Alzheimer’s Patient in Pain

(ĐTĐ) – One troubling consequence of advanced Alzheimer’s disease is an increased deficit in communication due to decreased cognitive abilities. Because a patient with late-stage Alzheimer’s has difficulty both understanding and communicating with others, they are not able to understand pain that they may be experiencing or communicate to others that they are in pain.

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Alzheimer’s patients actually receive fewer prescriptions for pain medication than the general population. Because the pain is arising from another condition or an injury instead of Alzheimer’s disease itself, and Alzheimer’s patients can definitely feel pain, you would expect that the number of pain medication prescriptions should be similar in both groups.

In fact, functional MRI studies of the brains of Alzheimer’s patients and healthy individuals show that the same pain signals last longer in the brains of Alzheimer’s patients. This is probably because the advanced Alzheimer’s patients are not as capable of understanding why pain is occurring, so it is a more distressing intrusive force to them. These results have the implication that caregivers and doctors working with Alzheimer’s patients need to be attentive to signs that their loved one or patient is in pain and treat the pain to improve quality of life and reduce suffering for the patient.

Treating the Alzheimer’s Patient in Pain

Since pain is a subjective experience, there is no test to see if a patient with advanced Alzheimer’s disease is in pain or not. If a doctor does not work with the patient very much, it may be very difficult to tell if the patient is in pain or just confused. Long-term caregivers of the patient, such as a nurse that spends a lot of time with the patient or a relative of the patient, are more likely to notice when an Alzheimer’s patient is experiencing pain. They are familiar with the baseline behavior of the patient, so any changes in the patient’s behavior or disposition are noticed. These changes don’t necessarily mean that the patient is in pain, but it is a good reason to have a doctor examine the patient for any potential problems.

One aspect of treating Alzheimer’s patients in pain is to treat the symptom of pain itself. The pain, not the condition causing it, are what is distressing and confusing the patient, so the symptom needs to be taken care of to improve the patient’s quality of life. For some types of pain, like mild arthritis, muscle cramps and tension headaches, over-the-counter medications such as non-steroidal inflammatory drugs (NSAIDs) are sufficient. In other cases, a doctor may prescribe larger doses of NSAIDs or a narcotic pain medication. It may be extremely difficult to get an Alzheimer’s patient with an advanced case of the disease to take oral medication, however, so intravenous injections in a doctor’s office or by a caregiver may be necessary in some cases. Alzheimer’s disease patients are also incapable of remembering to take their medication by themselves, so the caregiver must do this for them.

The other major aspect of treating Alzheimer’s disease patients who are in pain is to treat the underlying condition that is causing the pain. Hopefully, the condition can be taken care of so the patient does not have to continue to take pain medication on a long-term basis. The problem is that patients with Alzheimer’s disease can suffer all of the same painful conditions as anyone else. In fact, they are even more likely to suffer from some conditions, such as lung infections that can cause pneumonia and chest pain, because of their Alzheimer’s disease. Patients with Alzheimer’s disease are just less likely to understand their pain sensations, attribute a specific cause to the pain and be able to describe the pain to others.

Any infections, such as lung infections and urinary tract infections, can be treated with oral or intravenous antibiotic medications. Infections need to be treated as soon as possible because they have the potential to spread to other parts of the body and cause more serious conditions, such as septic shock. Injuries, such as broken bones, strains and sprains, are treated the same way that they are treated in non-Alzheimer’s patients, but there are added complications to treatment because of Alzheimer’s disease. Some types of arthritis require medications other than pain medications. Headaches, back pain and toothaches are also common potential causes of pain in Alzheimer’s patients.

In general, treatment for any condition is the same as it is with a non-Alzheimer’s individual, but it is more difficult in practice because of the patient’s dependence on a caregiver. With symptomatic treatment of pain symptoms and treatment for underlying conditions that are causing the pain, the suffering and confusion of Alzheimer’s patients is reduced and quality of life is increased.


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