Patients with impaired cognition face the risk of inadequate pain control because they cannot report the characteristics of their symptoms.

Two common risk groups in palliative care include:
• Patients with dementia, Parkinson’s disease, stroke, or developmental abnormalities.
• Patients receiving sedating medications.

Strategies to assess pain in these patients:
• Ask the patient: many patients who appear cognitively impaired may still be able to provide useful information about pain.
• Interview the caregivers and family: particular behaviors may indicate pain (e.g. placing a hand on the forehead for headache).
• Review the medical record for known pain-inducing pathology.
• Complete a physical examination and focused laboratory studies to assess for common pain-inducing problems (e.g. fracture, urinary tract infection).

In addition to these strategies, health professionals should use a validated pain rating systems for the cognitively impaired that focus on the following observational items:
• Appetite
• Body posture
• Facial expression
• Interactivity
• Vocalizations

See reference for more information about rating scales.

Adapted from Wilner LS., Arnold R. Pain assessment in the cognitively impaired. Palliative Care Network of Wisconsin. Fast facts and concepts #126. Internet. Accessed on December 27, 2018.