Tag Archives: pain

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Pain In Dementia Is Often Not Recognised or Treated

 

Pain in people with dementia is under-assessed and undertreated.

Antipsychotic drugs, sedatives, antidepressants and many other drugs are often prescribed to people with dementia. Anxious, distressed and aggressive behaviour may be the result of pain, which in some cases the person with dementia cannot express or communicate.

If it is difficult or impossible to assess if a person with dementia has pain, would it not be a great step forward to try painkillers for a short period and assess the effect, before commencing all the sedatives?

Click here for Pain Assessment for Residents with Communication Issues

Click here for Nursing Care Plan for Pain which incorporates an Assessment Tool.

 

Analgesia Awakens Alzheimer’s Patient From Dementia

Click here to view some real success stories of people with dementia improving dramatically after being given painkillers.

My friend’s mother has very advanced dementia and was extremely unsettled, agitated and could be extremely angry and aggressive at times.

She had never complained of pain nor showed signs of being in pain when she was being cared for.

She fractured her femur just over a month ago and was commenced on strong analgesics post operatively.

Her behaviour and quality of life changed almost immediately. She has continued on analgesics regularly and continues to have a much improved quality of life.

She is now settled, calm and  and enjoys spending time with her husband and family.

Her family are so upset that for years no one realised she was in pain.

A review in the Nursing Times discusses the main barriers to effective assessment and management of pain in people with dementia

5 key points

An estimated 115 million people could be affected by dementia by 2050

The prevalence of pain in older people is estimated to be 25-50%

People with dementia receive fewer analgesics than their counterparts who are cognitively intact

One study found three quarters of care homes did not use standardised pain assessment tools

Attitudes and beliefs among patients and nurses can be substantial barriers to effective pain management

People With Communication Issues Can Not Complain Of Pain Or Express Pain

Doctors often are not able to determine if a person with dementia has pain.

Nurses likewise may consider that people with dementia cannot reliably report pain or any change in the level of pain.

Correctly Assessing and Meeting Peoples Needs Improves Quality of Life

A simple tool, based on the ‘PAINAD’ (Pain Assessment in Advanced Dementia scale) could help:

P – Pick up on mood (are they withdrawn or irritable?)

A – Assess verbal cues (are they muttering under their breath, moaning or crying out?)

I – Inspect facial expressions (are they grimacing or looking frightened?)

N – Notice body language (are they pacing, clenching their fists, fidgeting or curled up as if trying to hide?)

Use of assessment tools and guidelines

Increasing the use of assessment tools would assist Nurses and carers in recognising pain.

Education for staff

All staff need training and guidance to be able to care well for a person with dementia. They need training to understand the complex issues of the condition, and how important empathy and understanding are.

Assessment of Pain

Consistency of care with residents with dementia is extremely important in assessing pain and delivering excellent person centred care.

Headmistress jumped from bridge one year after 14-year-old pupil’s identical suicide

A HEADMISTRESS jumped to her death from almost the same spot on the Humber Bridge where her pupil had killed himself a year before.

Jane Disbrey, 59, the head of Malet Lambert School, Hull, was tormented by chronic facial pain and chose to mimic the suicide of 14-year-old William Shaw.

An inquest heard the headmistress got her hair done at a salon before driving to the bridge on August 4.

The mother-of-two and leading light in local education circles – described by one pupil as having “a smile for everyone”– drove from her West Ella home to Hessle, where she left her Saab in the Humber Bridge car park.

A young couple, who had been travelling along the bridge, described how Mrs Disbrey appeared to look at them, before letting go of railings and falling.

Schoolboy William was found in a field on the Hessle Foreshore after he jumped from the same area of the Humber Bridge, on September 17, last year.

After William killed himself Mrs Disbrey said: “We are truly saddened by the sudden passing of William and offer our deepest sympathies to his family and friends at this time.

Mrs Disbrey’s husband Stephen told an inquest into her death she had suffered severe facial pain since August, last year.

“Jane always wanted an instant solution to the pain that she was in, but it was explained to her that it was a very difficult illness to treat,” said Mr Disbrey.

“She had told herself she would never get better.”

Mr Disbrey said they had not long returned from a holiday in France when she died.

He said: “I had no reason to doubt her when she said she was going to see a friend.

“It was only when I realised she had left some key personal items at home that I became concerned.”

In a statement, Emma Bradshaw, a counselling psychologist who saw her on June 20, said: “Her eyes felt like paper cuts every time she blinked. She said she had been off work for five weeks.

Professor Paul Marks, senior coroner for Hull and the EastRiding, recorded a narrative conclusion.

“She did not express any suicidal ideation on the last day of her life, but was seen to jump from the Humber Bridge on the 4th of August, 2015 after 6pm, and died instantaneously from multiple injuries sustained as a result of the fall.”

A statement from Malet Lambert School read: “Jane Disbrey created a culture of excellence and will be greatly missed.”

Source The Sun

Dementia patients’ rages may be entirely due to pain

The Mail Online reported on a really relevant and very important article on dementia.

“Ann Pascoe’s husband Andrew had always been a gentle, mild-mannered man. So when he was diagnosed with dementia seven years ago, she expected him to be forgetful and become more dependent – what she was not ready for were his aggressive outbursts.”

‘It was incredibly upsetting and I was permanently walking on eggshells but thought that this must just be part of the dementia, I was getting to the stage where I felt I couldn’t cope any more’ she said.

After andrew developed dementia, from time to time he would get very agitated - and even throw things

Then, last August, Andrew had fainted at the bus stop in the village near where the couple live in Helmsdale, Scotland.

On examination the doctor diagnosed Andrew with neuropathic pain in his legs and he asked if Ann would keep a ‘pain diary’ for two weeks.

Ann’s diary showed that Andrew was in considerable pain a lot of the time and the doctor prescribed him Gabapentin, an epilepsy drug which interrupts the transmission of pain signals in the brain.

According to a recent review in the journal Clinical Intervention In Ageing the major cause of aggression and agitation is untreated pain, however many patients are given inappropriate sedation.

800,000 people in this country have dementia and they tend to be older and therefore more prone to aches and pains.

‘It is vitally important that care professionals have the tools and training to meet the complex needs of people with dementia.’

Can you imagine what it would be like to be in pain but not have the ability to express yourself?

Nurses and carers need to really observe and assess if a person with dementia is in pain.

Our Pain Care Plan incorporates a recognised and effective assessment tool for assessing pain in a person who cannot tell you they are in pain. Click here to buy it.

Where it is impossible to assess the patient or residents level of pain, due to their condition, would it not be a lesser evil to try pain relief?

What you think?

To read the full article Click here Mail Online

Scientists discover how to ‘turn off’ pain: Threshold can be raised by altering chemistry in the brain

Patients can be made more resistant to pain by altering the structure of their brains, scientists believe.

New research has raised the possibility of creating more effective treatments for people who suffer from chronic pain – which could be as simple as encouraging them to take more exercise.

Scientists discovered for the first time that people left in agony by arthritis develop more receptors in the brain that respond to opiate pain relief.

Having extra receptors makes the body more resistant to pain – both by using our bodies’ natural painkillers, endorphins, and through prescribed opiates such as morphine.

The researchers believe that if we can find out how the body increases the number of opiate receptors, we will be able to improve pain relief treatments.

Nearly half of the UK population are thought to have suffered from chronic long-term pain – lasting six months or more – and one in five consultations with GPs are for this complaint.

But some people seem to cope better with long-term severe pain, leading scientists to investigate which coping mechanisms were at work.

The University of Manchester team found that the more opiate receptors an individual has, the better able they are to resist pain.

To test the theory, the scientists warmed the skin of patients with a laser to measure how much pain they could withstand.

They then scanned their brains with a PET scanner to count the number of opiate receptors.

They found that arthritis patients who had suffered more recent severe pain had more opiate receptors.

Professor Anthony Jones, director of the Manchester Pain Consortium, said: ‘This is very exciting because it changes the way we think about chronic pain.

‘There is generally a rather negative and fatalistic view of chronic pain. This study shows that although the group as a whole are more physiologically vulnerable, the whole pain system is very flexible and that individuals can adaptively increase their resilience to pain.

‘It may be that some simple interventions can further enhance this natural process, and designing smart molecules or simple non-drug interventions to do a similar thing is potentially attractive.’
Researchers believe that increasing the amount of exercise we do could increase pain resistance (file photo)

Researchers believe that increasing the amount of exercise we do could increase pain resistance (file photo)

Prof Jones said that as well as drug treatments, something as simple as taking exercise could also boost opiate receptors.

‘We know that exercise can activate the natural opiate system in the brain,’ he told the Daily Mail.

‘What we don’t know is how it regulates how many opiate receptors we have. Having more exercise might increase the number of opiate receptors.’
 The notion of enhancing the natural opiates in the brain, such as endorphins, as a response to pain, seems to me to be infinitely preferable to long term medication with opiate drugs.
Val Derbyshire, patient

Fellow researcher Dr Christopher Brown, from Manchester University, said: ‘As far as we are aware, this is the first time that these changes have been associated with increased resilience to pain and shown to be adaptive.

‘Although the mechanisms of these adaptive changes are unknown, if we can understand how we can enhance them, we may find ways of naturally increasing resilience to pain without the side effects associated with many pain killing drugs.’

Val Derbyshire, a patient who suffers chronic pain from osteoarthritis, said she was ‘extremely interested’ in the research.

‘I feel I have developed coping mechanisms to deal with my pain over the years, yet still have to take opioid medication to relieve my symptoms,’ she added.

‘The fact that this medication has to be increased from time to time concerns me greatly, due to the addictive nature of these drugs.

‘The notion of enhancing the natural opiates in the brain, such as endorphins, as a response to pain, seems to me to be infinitely preferable to long term medication with opiate drugs.

‘Anything that can reduce reliance on strong medication must be worth pursuing.’

Opiate receptors were first discovered in the brain in 1973. Since then they have been found to have several different sub-types with different roles.

 
Source Mail Online

Detecting when a person with dementia is suffering from pain is so important

In an excellent article recently in the Guardian, Jo James, dementia lead at the Imperial College Healthcare Trust and stalwart champion of John’s Campaign from the start, told the story about her own mother’s unidentified pain in hospital.
 
Her mother had advanced dementia when she sustained facial injuries after a fall.

She had 60 stitches to her face, a broken cheekbone and nose and the loss of most of her front teeth.

She had been given nothing for pain. The nurse said: “Don’t worry. She won’t be in any pain.”

The clinicians looking after Jo’s mother simply had not thought about pain and she could not tell them.

Research shows that people with dementia receive significantly less pain relief than others when they are in hospital.

The thought of someone being in terrible pain with no hope of respite from it is hard to imagine, and combined with all the other challenges facing a person with dementia, it also seems tremendously unfair.

However, the solution is simple and requires no specialist knowledge or training.
 
Simply being aware of the possibility of pain and flagging it up so that the person can be given some relief is all that is required and is something that we can all do.

Nurses and doctors need to become much more sensitive to the fact that the person with dementia may be in pain.

If they had any kind of past physical issue or condition such as arthritis, back pain, shoulder pain, or any aches and pains, they will most likely continue to experience that issue as they develop dementia.

Their physical issues don’t disappear.

They may not be able to communicate the fact they are in pain.

Our approach is to carry out an assessment which incorporates all potential physical signs and the past history of any painful condition.

This has been really successful.

Recently a lovely gentleman was admitted to our Care Home. He was admitted from a psychiatric assessment ward.

On admission he was prescribed numerous, medications including antipsychotic drugs, sedatives and tranquilisers.

His behaviour was extremely agitated and anxious most of the time.

He appeared to be very frustrated, and could not communicate verbally, and it was not clear at all that he was in pain.
 
He was prescribed an analgesic as required in the hospital but he did not receive it regularly.

We asked the doctor if we could try giving the pain relief regularly for a two week period to see if this helped him, as the gentleman was unable to communicate he was in pain. He agreed.

The difference was amazing. His wife could not believe the transformation in her husband. He is now calm, content, and at peace with himself and others.

He enjoys his food more, he participates in most activities, and he smiles and engages with the staff and his family more than he has done since his disease was diagnosed.

He also is speaking and communicating much more than he did, previously.

His quality of life has improved tremendously.

It makes complete sense especially if the person with dementia is elderly.

Their joints, bones tendons and muscles suffer wear and tear, and arthritis can set in.

To try analgesics in the assessment period is a sensible approach.

Too often when residents appear agitated, anxious or aggressive the only remedy appears to be sedation or antipsychotics.

This should not always be the case.

Click here for an excellent comprehensive pain assessment tool for people with dementia or who cannot communicate that they are in pain.

Listening to music before and after surgery relieves pain and anxiety

Patients undergoing surgery should be allowed to listen to music before, after and during their operations because it is so effective at relieving pain, researchers have suggested.

A new study by Brunel University and Queen Mary University of London found that people who were allowed to relax to their favourite tunes saw their pain levels drop by two points on a scale of one to 10 while they needed less medication to feel comfortable.

The study of 7,000 surgical patients also found music made them less anxious and more likely to feel satisfied by the procedure.

Surprisingly, even listening to music while under general anaesthetic reduced patients’ levels of pain, although the effects were larger when patients were conscious.

“Around 4.6 million in England each year and music is a non-invasive, safe, cheap intervention that should be available to everyone undergoing surgery,” said lead author Dr Catherine Meads from Brunel University

“Patients should be allowed to choose the type of music they would like to hear to maximise the benefit to their wellbeing. However, care needs to be taken that music does not interfere with the medical team’s communication.”

The study follows a recent research that found patients are being put at risk by surgeons who listen to music while operating.

An analysis of 20 operations by Imperial College London found that nurses struggle to hear what equipment was being asked for while anaesthetists mistook the beat of the music for patient’s pulse rate.

However, for patients themselves, it appears that music can have a major impact, and could save the NHS millions in pain relieving drugs.

Writing in a linked Comment, Dr Paul Glasziou from Bond University, Queensland, Australia says, “Music is a simple and cheap intervention, which reduces transient discomforts for many patients undergoing surgery.

“A drug with similar effects might generate substantial marketing…The very high heterogeneity…of effects among trials in the accompanying study highlights a research opportunity—to identify how to maximise the effect.”

The research was published in The Lancet.

Source The Telegraph

Crossing your fingers may help reduce pain

“Crossing your fingers might reduce pain,” says The Guardian. The study behind the news found crossing your fingers may confuse the way your brain processes feelings of hot and cold – and, in some cases, reduce painful sensations.

Rather than subjecting the participants to “normal” pain, the authors used a trick known as the thermal grill illusion. The thermal grill illusion is not the latest in BBQ technology, but an unusual – and well validated – phantom pain effect.

When the skin is subjected to an alternating pattern of harmless coldness followed by heat, it creates a sensation of “burning coldness”, but does no damage to the skin. It is something akin to the burning sensation felt by anyone placing cold hands under warm water after a snowball fight.

The researchers applied hot and cold sensations to the ring, middle and index fingers to create phantom pain sensations in volunteers. The phantom pain reduced in some people when they crossed their fingers.

This artificial phantom set-up means the findings probably don’t apply to most real-life experiences of pain. Would a woman crossing her fingers during childbirth feel some benefit, or would someone who has just hit their thumb with a hammer? Probably not.

We shouldn’t get too hung up on the crossed finger idea, though. The concept behind it is more interesting. The study tentatively showed that pain might be influenced by how our bodies are organised in space and relative inputs from different parts of your body.

If it is found to be a regular and real occurrence through more research, this may have potential for use in pain management in healthcare.

Where did the story come from?

The study was carried out by researchers from University College London (UCL) and the University of Verona (Italy).

It was funded by the CooperInt Program from the University of Verona, the European Union Seventh Framework Programme, the Economic and Social Research Council, and the European Research Council.

The study was published in the peer-reviewed science journal Current Biology.

The Guardian reported the story accurately, making it clear it was not real-world pain, but phantom pain from the thermal grill illusion.

The paper interviewed Elisa Ferrè of UCL and a co-author, who said: “There might be applications for treating people with chronic pain … the position of your limbs or digits is something that would be very easy to manipulate.”

Adding a welcome note of caution, The Guardian wrote: “The findings did not establish whether crossing your fingers would be as soothing with a real painful stimulus, rather than an illusory one, but Ferrè said her hunch is that it would help.”

What kind of research was this?

This was a study of human volunteers investigating whether pain perception is influenced by the position of their fingers.

Rather than subjecting the participants to conventional pain, the team used a trick known as the thermal grill illusion to create a phantom pain sensation.

Controlled experiments such as these are useful for developing new ideas and testing them in the early stages. But testing pain in an indirect manner like this isn’t ideal. It would be more useful to devise a test using actual pain, but this has ethical dimensions to consider.

What did the research involve?

The researchers used three heat pads under the index, middle and ring fingers of participants to test different combinations of the thermal grill illusion, and whether crossing fingers reduced the phantom pain.

Participants also adjusted a temperature delivered to the other hand until it matched their perception of the cold target finger (index or middle).

The thermal grill illusion works by applying a warm sensation to the index and ring fingers, and a cold sensation to the middle finger. The grill-like pattern of warm-cold-warm creates a burning sensation in the middle finger, even though it is in fact exposed to cold.

About half of people go as far as describing the feeling as painful. The sensation is much more intense than the hot or cold on their own.

According to the researchers, the illusion might work because the hot sensation in the outer two fingers blocks the activity in a certain cooling receptor under the skin. With this pathway blocked, the hot signals from the nearby hot areas are felt more intensely.

What were the basic results?

The study found significant temperature overestimation when the target finger was in the middle (warm-cold-warm) compared with on the end (cold-warm-warm).

The effect depended on the target finger being in the middle of thermal inputs, but it didn’t matter whether this was the index or middle target fingers.

The thermal grill effect for the middle finger was abolished when it was crossed over the index. The same effect was generated for the index finger when it was crossed with the middle.

How did the researchers interpret the results?

The team concluded that, “Our results suggest that the locations of multiple stimuli are remapped into external space as a group; nociceptively mediated sensations [pain perception] depended not on the body posture, but rather on the external spatial configuration formed by the pattern of thermal stimuli in each posture.”

Conclusion

This study investigated pain using a thermal grill trick, which applies hot and cold in different combinations to the index, middle and ring fingers to induce a phantom burning sensation.

This showed that crossing your fingers may confuse the way your brain processes feelings of hot and cold, and in some cases stopped the phantom pain.

The biggest limitation of this study is that it looked at phantom pain using the thermal grill trick, rather than actual pain. Phantom pain may be different from “normal” pain, so the results may not relate to a regular pain situation.

We shouldn’t get too hung up on the crossed finger idea, though. The concept behind it is more interesting. The study tentatively showed that pain might be influenced by how our bodies are organised in space, and relative inputs from different parts of your body.

If found to be a regular and real occurrence through more research, this may have potential for use in pain management in healthcare.

For example, The Guardian says: “Scientists believe the phenomenon could ultimately be harnessed to help treat chronic pain patients, who suffer from painful sensations, often long after a physical injury has healed.”

At present, this is largely speculative. The study only showed reduction in phantom pain, and only under a very specific and artificial set of circumstances. Research that is more relevant and applicable to real life would be the logical next step for this research field.

Still, how we think about pain can sometimes alter how it much it affects us. Many people find cognitive behavioural therapy (CBT) techniques can be useful in helping people cope better with chronic pain.

Sourced from the NHS News Online

People with dementia in hospital struggling with undiagnosed pain, study finds

The frequency of pain experienced by people with dementia in hospital may be dramatically underreported, according to new research from UCL published in the journal PAIN today 25 March 2015.

Please click here for a comprehensive pain assessment for residents with communication issues.

An observational study of 230 people with dementia from University College London found that, while nearly two thirds (57 per cent) of people with the condition were observed to experience pain, fewer than 40 per cent were able to report it due to the nature of their condition.

The research, funded by Alzheimer’s Society and led by UCL’s Dr Liz Sampson, saw academics assess people with dementia in two UK hospitals.

Participants were assessed every four days for self-reported pain and also observed by the study team over the course of their stay in acute care.

The team asked participants to answer to ‘yes/no’ questions as well as measurements on the FACES scale, a self-reporting pain scale based on asking people to point to drawings of faces of people in pain. Up to 39 per cent of participants self-reported that they were in pain.

However, upon observation by academics, 57 per cent of the cohort were judged to be in some form of pain. The researchers also found a strong association between pain, aggression and anxiety.

Ninety per cent of people with dementia experience behavioural and psychological symptoms of dementia (BPSD) which can include these symptoms as well as agitation.

According to the researchers, some BPSD could be to do with under detected or under managed pain, often triggering a cycle of poor care in a stressful environment.
George McNamara, Head of Policy and Public Affairs at Alzheimer’s Society, said:

    ‘It is not right that people with dementia are experiencing pain which is going unreported in a place where they go to get well. No one goes into care to do a bad job, and yet we hear regularly that front line staff don’t have the training they need to manage the complex reality of dementia. We need to empower and train staff to deliver quality care to manage pain.

    ‘One in four hospital beds are occupied by someone with dementia. We want to see all NHS staff empowered to deliver the best quality care including recognising and managing pain where it occurs. A national standard for training of NHS staff would be a step forward in ensuring quality care is the norm across the NHS.’

Dr Liz Sampson, Senior Clinical Lecturer at University College London whose work is currently supported by the Marie Curie Palliative Care Research Unit, said:

    ‘Hospitals are challenging places for people with dementia to be – they are unfamiliar surroundings which can be noisy, frightening and confusing. This can cause them great distress. It is very difficult to detect and treat pain in people with dementia, who often have difficulty expressing themselves or remembering that they have experienced pain. Sometimes people with dementia can try and communicate pain through challenging behaviours such as aggression or shouting out.’

The researchers found that pain was common in people with dementia who were admitted to hospital – nearly 40 per cent were in pain on at least one occasion during the time and nearly 60 per cent had pain on movement during their hospital stay. Being in pain was strongly associated with aggressive behaviours and anxiety.
Dr Sampson continued:

    ‘We believe that improving pain management for people with dementia may reduce distressing behaviours and improve the quality of hospital care they receive. If staff understand that a change in behaviour in someone with dementia might indicate they are in pain, they can take simple measures to help with this. Staff are stretched in terms of time and resources, so we need to raise awareness, improve their training and increase specialist psychiatric support services within hospitals.’

Professor Bill Noble, Medical Director at Marie Curie said:

    ‘The more we learn about dementia, the more we see how distressing the condition is, especially when it comes to the pain people with dementia feel but can’t express.

    ‘This important study – the first of its kind in a general hospital setting – tells us that pain felt by people with dementia when in hospital can manifest as difficult or aggressive behaviour. By identifying this link, medical staff can better understand what people with dementia might be experiencing when they can’t communicate it. We hope this knowledge will help improve the care people with dementia receive, help reduce their pain and improve their experience in hospitals, as well as minimising the stress of their families and carers.’

Source Alzheimer’s Society

Study shows mind-control techniques can help manage chronic pain

A new study by a researcher at the University of Reading has found that painful areas on our body can be controlled through the power of positive thinking.

In a study led by Dr Tim Salomons, healthy participants were given five minute spells of cognitive behavioural therapy (CBT) before having eight, hour-long sessions of heat applied to their forearm to evoke pain.

This created areas of secondary hyperalgesia – a measure of pain sensitivity in the area surrounding injuries such as burns.

By managing their negative thoughts the group managed to reduce the physical symptoms of secondary hyperalgesia by nearly 40 per cent.

Secondary hyperalgesia is an example of central sensitisation, where pain sensitivity is enhanced by the central nervous system.

Although not a replacement for other forms of treatment the results are good news for those who suffer from conditions like lower back pain and fibromyalgia, as central sensitisation has been observed in chronic pain disorders.

CBT focuses on examining negative beliefs and changing thoughts that are distorted and unhelpful and is used widely to treat mental health issues and ‘emotional’ pain.

The new research showed that CBT can actually alter the body’s physical responses to pain after injury.

Dr Salomons, from the university’s School of Psychology and Clinical Languages, conducted the work at the Toronto Western Research Institute during his previous role at the University of Toronto.

He said: “Chronic pain is a debilitating and common complaint. Over five million people in the United Kingdom develop chronic pain each year.

“Of the 34 participants given secondary hyperalgesia, half were trained to control negative thoughts related to the pain by, the other half was given training unrelated to the pain stimuli.

“We then examined the groups’ secondary hyperalgesia. The results were striking. The ‘pain-trained’ group achieved a 38 per cent reduction in secondary hyperalgesia, while the control group reported an increase of just 8 per cent.

“We know that pain feels more debilitating when it signals illness or injury compared to when we are undertaking an activity we feel is beneficial – we go through the pain barrier. However we didn’t know whether our beliefs simply changed the emotional response to pain or if the mind actually changed sensations that arise from the body – until now.”

The study also showed we can reduce our emotional response to a painful stimulus, such as the fear we feel before being injected with a needle.

Dr Salomons added: “The trained group also reduced the ‘unpleasantness’ they were feeling during the eight sessions by 58 per cent. This indicates that the training changed the emotional response to pain as well as the sensitivity of the skin around the burn.”

Dr Salomons believes that the accessibility of this type of training would allow individuals who suffer from enhanced pain sensitivity to practice pain reducing techniques in their own time.

“The CBT instruction was adapted almost entirely from a commonly available manual. ‘At-home’ cognitive treatments, working in tandem with other treatments, could make a difference to NHS finances and waiting times as well improving the lives of chronic pain sufferers.”

Dr Salomons conducted this research at the Toronto Western Research Institute in conjunction with Dr Karen Davis. The paper was published online this week in the journal Pain.

Source Get Reading

Care homes found wanting in pain management for dementia

Unqualified care workers are routinely assessing pain in patients with dementia in nearly half of independent care homes, indicates a survey carried out by Napp Pharmaceuticals.

It conducted a survey of 100 independently owned care homes on the provisions they had in place for identifying and managing pain in dementia patients.

Just under half of the care homes questioned, 46%, reported that support workers regularly assessed pain.

In addition, 22% of homes surveyed in England had no written guidelines in place for assessing pain in those less able to communicate, rising to 25% for homes in Wales.

Meanwhile, as many as 30% of the homes surveyed had not reduced their use of antipsychotics in dementia, despite government guidelines  to do so, and 54% reported that less than half of their patients were currently taking analgesics.

Commenting on the findings, Alzheimer’s Society chief executive Jeremy Hughes said: “People with dementia can struggle to communicate and may find it difficult to express that they’re in pain.

“This means they miss out on being given pain relief and suffer in silence or, even worse, are given dangerous antipsychotic drugs.”

He added: “Training and supporting staff enables care homes to provide the best quality care possible and allows people with dementia to be treated with the dignity and compassion they deserve.”

The pharmaceutical company, which has a background in pain medicines, has created the “See Change: Think Pain” awareness campaign for carers and healthcare professionals to help identify pain in people with dementia. It includes a simple mnemonic to assist carers:

    Pick up on mood changes
    Assess verbal cues
    Inspect facial expressions
    Notice body language

Source The Nursing Times