A study by Help the Aged in 2008 identified that “Older people are more likely to experience pain, less likely to complain about it and less likely to comply with medication”.

(Schofield and Reid, 2006).Chronic Pain in the Population

Although hard to quantify, research suggests that up to 80% of people living in a care home suffer from chronic pain.

It is important to remember that pain is not an inevitable part of ageing.

What is Chronic Pain?

Primarily, pain is what the person says it is.

Pain is personal to each individual and someone’s description of pain should be respected and trusted.

One of the most important things I learned at the start of my nursing career is that if carers can understand that pain is a subjective experience then they may better be able to show empathy to the people that they look after.

Chronic pain is defined as any pain that lasts for longer than twelve weeks. Chronic pain may arise from an initial injury and then persist, or it may be the symptom of a disease. Sometimes there is no known cause.

What is the Impact of Chronic Pain?

Older people are less likely to complain about pain, yet it is described as one of the biggest threats to an older person’s dignity.

Some of the effects on a person living with chronic pain include: 

  • Insomnia
  • Depression
  • Anxiety
  • Change in/Loss of appetite
  • Change in activity status
  • Overall reduction in quality of life

Chronic Pain & Cognitive Impairment

Pain in people with cognitive impairment is often under diagnosed.

Challenging behaviour can be viewed as merely a symptom of dementia and in reality, the challenging behaviour may be a response to pain in a person living with dementia.

Furthermore, pain can exacerbate the behavioural and psychological symptoms of dementia. 

Barriers to Effective Pain Management

  • Lack of training/knowledge in carers responsible for assessing pain in older people
  • Concerns regarding regulatory scrutiny
  • Fear of opioid related side effects
  • Lack of ability to assess pain in people with cognitive impairment
  • Use of agency/bank staff leading to reduction in pain recognition, especially in people with cognitive impairment or dementia
  • Assumption that pain is an inevitable part of ageing
  • Concerns from the resident themselves, fear of addiction, fear of side effects, fear of being perceived as a nuisance patient
  • In the care home, barriers around time and cost

Effective Pain Assessment & Management

One of the largest barriers to effective pain management is the poor assessment and documentation of pain, its management and evaluation of effectiveness.

Getting It Right

The use of a comprehensive pain assessment will help carers to monitor patterns and triggers and to demonstrate to their GP when pain is reviewed.

It is also equally important to document the effectiveness of current treatment plans. 

As previously identified, it can be harder to identify pain in people living with dementia and cognitive impairment.

Being able to adapt the pain assessment tools to meet the needs of the resident will further improve the pain assessment process.

Pain management and its documentation is an area the CQC will look at during an inspection,to ensure pain is being identified and managed effectively. 
“The CQC found that some care plans did not include information about how individuals communicated that they were in pain, leaving staff to rely on their own judgement. Patients were therefore put at risk of suffering without respite or receiving inconsistent pain relief”.

(Cracks in the Pathway, 2014).  

Pain can have a severe impact on a person’s quality of life, and their dignity.

It is crucial for carers to utilise methods and tools to use alongside their clinical judgement to assess and manage pain in older people, particularly those who may not be able to express that they are experiencing pain.

Read more Nursing Notes by Claire Bailey.