Pain is one of the most common but under-recognised and undertreated symptoms of dementia. People with dementia experience physical and psychological pain, which they may struggle to express, particularly during the advanced stages of the disease. Non-verbal ways of expressing pain include:

• Facial expressions (frowning, grimacing or looking frightened)
• Vocalisations (groaning, sighing or breathing loudly)
• Movements (rigid posture, tension, rocking or gait changes)
• Behaviour (refusing food, changing routine or wandering)
• Mental status (confusion, crying, irritability or distress). People are often assessed for pain while lying or sitting.

However, pain mostly occurs when the person is moving. The Royal College of Nursing suggests that pain is assessed systematically when people are moving, as well as when still. Analgesia should be administered before doing anything that may cause pain. If possible, self-reported pain assessment scales should be used in people with mild to moderate dementia and observational pain tools used in severe dementia.

A study revealed that a systematic approach to pain management could significantly reduce agitation in nursing home residents with moderate to severe dementia. The authors concluded that effective pain management can play an important role in the treatment of agitation and could reduce the number of unnecessary psychotropic drug prescriptions in this population.