When I first got the pain before the morphine, you give a score up to ten. I was nine.
Really hard, sharp, fierce jabs of pain.
I would certainly encourage Tom to say if he was in pain, but at the same time recognising that his
idea of pain is probably very different to mine. And that he might not express that
he's in pain until he's in very severe pain. Pain's one of those things that
can really make people feel miserable, totally disinterested, not want to be involved in anything
and, actually, if you alleviate the pain, you actually lift people's moods. You'll make them feel
so much better and they'll get far more involved in what's happening around them. People will express
pain in different ways because there's so many different types of pain that people can experience.
We need to understand what those different forms of pain are. So it might be emotional pain, it
might be physical pain, it might be a sense of loss. So some people can tell us you know
'my arm hurts, my leg hurts', but equally some people can't tell us, so then we've got to pick up
on what's happening with that person to identify that they're experiencing pain. And it may be that
they wince when they move. It may be that they're constantly rubbing an area. It's all those subtle
things that we have to be very aware of so that we can then take the appropriate action.
You'll see various things like hand massage, head massage, foot massage.
You'll also see things like physiotherapy, so that can alleviate pain when it's related to joint
stiffness and contractures. Obviously, there's always medication and, you know, frequently
we look at giving people medications such as paracetamol to alleviate any physical pain.
I can just look
at Jack and know there's something wrong with him. I can just know by looking at his face.
Well, I suppose you get used to people, you know. All the dos and the don'ts and what
the habits are so if these habits slightly change even if it's just a certain difference.
He just has this like worried look on his face, you know. But when people have dementia
particularly as dementia progresses, they have difficulty expressing
pain so they may still feel the sensation of pain but have difficulty expressing it. And
it's therefore under-recognised and under-treated. So we're off to visit Margaret and Jack, but today
we're going to talk to Jack about how he is how things are generally for him and how he's coping
in terms of any pain or distress that he might be feeling. With people's dementia, truly understanding
a person is very important. Good afternoon. Does pain cause you to get angry sometimes or get
frustrated? No not, not with that. Yes you do. What I don't get no, no. I don't get, I don't shout
and jump about. Well, you don't shout, but you do get annoyed. You get very – quite angry with yourself.
I've got arthritis or the stages of arthritis and the longer you sit and do nothing
the pain seems to increase. Where, if you get up and you walk about, you're moving all your muscles and
your bone ends are wiggling about and this it stops the pain. So really it's a case of getting
out and doing exercise, which keeps the arthritis away. And I mean sometimes on the morning he can
hardly walk when he gets out of bed, but he says once he's walked through his paper and come back –
It's just exercise really and walking for me papers and exercise, so when I come back I'm okay.
In early stages of dementia the
person may be able to express verbally if they are experiencing pain and seek medication
for that, if that's going to help. We need to be mindful that someone may forget to take medication
at an early stage or they may take medication and then take medication again because they've
forgotten they've already taken it. Medication management is very important in early dementia.
You forget. It just doesn't enter your head and
if – without Margaret prompting me, things don't get done. Yeah. And mainly my tablets. Right. With everything
else in your life. You'd think like after a few days you – I've got to take tablets every morning
but just doesn't enter your head. He said to me – she'll say 'have you took your tablets?'
'No'. And this is maybe 11 o'clock, and I'm supposed to have them between nine and ten. It's important to take
medication for pain as prescribed, but it's also important to keep it under review.
When you're trying to support people with pain, use comfort measures in terms of massage touch. We can
use baths as a nice form of relaxation, warm water. If someone with dementia has pain and it's not
treated or not considered, that can have a significant impact on their whole wellbeing.
You're going to lock the door, yeah?
Tom's generally very active. So he does things like gardening and conservation work, but he also
has just recently started going to the gym, which he really enjoys
Exercise can generally make you feel much better about yourself.
And it's equally important for any of us as it is for Tom
Tom has an incredibly high pain threshold and so it's not something that he would verbalise.
So, Tom, what happened yesterday then? Did you fall off the horse? Yeah. And what did you do? I
don't know, I don't know. So it's more a question of people looking for the tell-tale signs like
a hand on the shoulder or if he has a migraine he might go off to his room
hold his head in his hands. So it – that requires a response from other people you know. Tommy you
got a headache you know do you need a tablet? It's very important that there's a record of things
that have happened or things which are important for all members of the team to know about a person.
And it's exactly these sorts of things that are likely to come out. Tell me whereabouts it hurts.
I guess the most important thing for people who are supporting someone to manage pain is that they
know the person really well and that they know that – especially if the person doesn't express
pain – they know what the signs might be that somebody might be in pain so that they can
hopefully do something about it. Does it hurt anywhere else? No.
Pain is very
powerful and the level of pain is personal. Pain is what a person says it is. I feel the most
important thing is actually knowing the person and to nurture a sense of trust with that person.
Paul's medical conditions mean that he presents with many involuntary movements and he
he copes amazingly well with all that. When Paul has Reiki, then he is very still and he has
described periods of just beautiful relaxation. Normally, I can't keep myself still because
I've got Parkinson's – advanced Parkinson's. I've tried all sorts of different treatments, but
half of it is getting you to relax. When I come to here and get something like this, it's like magic.
If a person has a particularly strong relationship either with their GP or their district nurse then
in coming here it's important that they know that we communicate and work with them.
From a management point of view, if a drug is being designed for regular dosage. For example, if
a person has Parkinson's disease, then their drug regime may dictate that for optimum effect that
they are taken regularly. If a person can achieve a tolerable level of pain, for example, if they have
cancer, they can begin to feel whole again. I've came back today and before that I was
down in the dumps. Completely, utterly down there. And I didn't want to do anything. I didn't want to talk
didn't want nothing. After the initial shock of getting their fingers and everything and
the little pins. After that it starts to get a nice glow, it goes up.
Wherever the pain was, it seems to go away as well Really helps – a nice, warm glowy fire.
It's hard to describe but, you know, when you come in from the wind it's cold, you have a cup of nice whatever.
It really helps. The swelling's down and then I can get my shoes on again. I honestly think a lot is
in the mind and it's up here it's not there, not anywhere else and you need alternatives somewhere.
I was absolutely useless at art completely, but Edwin, the instructor, he taught us how
to look at things different. Well, you forget all about the pain because you're too busy engrossed.
I never really get lost in it. Pain management is all about holistic support and
just helping people to be who they are for as long as it can be. Try anything
get it out of your head because I'm 80 per cent sure that it's up here. Get the pain out, yeah.