title: Assessment and treatment of persistent pain in persons with cognitive and communicative impairment.
abstract: Pain management is a challenge when working with persons who have cognitive impairment that affects their ability to understand and communicate. This article focuses on pain assessment and treatment in persons who have dementia, but the challenges and principles are relevant to the spectrum of cognitive impairment. Fundamental principles guiding pain assessment and treatment in this population are (1) that behavioral disturbance is the result of an unmet need that causes discomfort, (2) that the behavioral disturbances that result from the unmet need of uncontrolled pain may be identical to those caused by other unmet needs (e.g., thirst, needing to toilet, understimulation, overstimulation, depression, psychosis, uncomfortable clothing), and therefore (3) that any pain treatment protocol for this population must target discomfort behaviors in general and then attempt to determine their causes. Pain assessment and treatment approaches based on these principles are outlined, and then two cases are presented to illustrate the application of these approaches.
authors.affiliation: Center for Mental Health and Department of Psychology, University of Alabama and Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL 35487, USA. lsnow@bama.ua.edu
authors.forename: A Lynn
authors.initials: AL
authors.lastname: Snow
authors.forename: John L
authors.initials: JL
authors.lastname: Shuster
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000150:complications; D002908:Chronic Disease; D002985:Clinical Protocols; D003704:Dementia / Q000150:complications*; D006233:Persons with Disabilities; D006801:Humans; D007326:Institutionalization; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods*