A review of Non-Verbal Pain Assessment Tools and Management in Patients with Dementia

Abstract

A widely held belief is that failure to acknowledge pain and its under-detection/diagnosis among elderly patients is common, and those clinicians often face challenges in pain among patients with cognitive impairment. This paper review pain assessment tools, and guidelines and practice for pain management in patients with impaired cognition. Using keyword including ‘dementia’, ‘pain assessment’, ‘physiotherapy intervention’, ‘modalities’, and elderly population’, PubMed and Google Scholar were searched for studies on pain assessment tools and its management amongst patients with impaired cognition and dementia. Available studies that met the relevant criteria were retrieved and were analysed to synthesise the best practices regarding pain assessment and management in people with dementia. Pain Assessment in Advanced Dementia Scale has the best psychometric properties and is preferred over other scales. As a guideline, it is recommended that clinicians may first determine the existence of and/or the extent of cognitive impairment using Mini-Mental Status Examination, identify possible causes of pain, observe patients behaviour and seek information from caregivers, before using any pain assessment tools. A clinician should consider non-pharmaceutical management of pain in this population with electrical stimulation standing out in this means of intervention. Managing pain in the elderly that cannot self-report pain require an interdisciplinary approach, comprehensive assessment and adherence to clinical guidelines for effective pain management. Transcutaneous Electrical Nerve and cranial nerve stimulation are potent adjunctive and perhaps choice modality over others in managing pain in dementia.