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:
• Body posture
• Facial expression
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.