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Hard to know how to care. At dentist office for a routine cleaning we found three abscessed teeth with a lot of infection. She had not complained of any pain and when asked she denies pain. Had a total hip replacement and never took any meds. Experienced a very very bad U.T.I. never with any recognition of pain. I'm beginning to think that the part of the brain that feels pain has been compromised. Is this possible? Has anyone dealt with this problem. She is able to converse for short conversations most of the time. During her adult life she had a high pain tolerance but this is unbelievable. Thoughts?

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We are experiencing the same thing with FIL. He's been in and out of afib lately. He should be feeling his heart racing, erratic beats, shortness of breath. He feels nothing. His left hand was swollen twice it's regular size and he did not feel it. I've also noticed he cannot tell what the temperature is outside by feeling the air (and the number associated with the temperature makes no sense to him) so he has trouble with what's appropriate clothing to wear for the day. There's a disconnect in his brain. Frustrating when there are so many medical issues going on and he cannot feel and articulate if there's pain involved or what he's experiencing, if anything.
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My mom went through same thing when it came to pain. She had always had high tolerance anyway but this was worse when she was going through the later part of dementia/alzheimer. She also had numerous health issues along with colostomy, UTIs (We'd start getting her checked for UTIs when her mood became even more erratic ) I was told by her doctor that some do lose sense of pain. Alzheimer is different in all people. My heart goes out to you and all
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The inability to perceive or respond to pain is quite common in person's with dementia, especially Alzheimer's, because of damage to the parietal lobes of the brain. The parietal lobes are located at the top and back of the skull. These lobes are responsible for your ability to feel and interpret pain, feel and respond to touch, taste foods correctly -- sweet, sour, bitter, savory, and for regulating the body's temperature. Some memory is also stored in these lobes.
As the disease progresses, the parietal lobes are eventually damaged and the result is an inability to feel and respond to pain correctly. Alzheimer's is considered a parietal lobe dementia due to the vast amount of damage occurring in these lobes. In some cases however, the opposite may be true. Sometimes persons with dementia may have extreme sensations of pain that gave no apparent causation.
Damage to the parietal lobes also means there is a craving for sweets or only the ability to taste sweets. They have an inability to properly regulate body temperature, hence persons with dementia have cooler body temperatures, but may not be aware of it. They also may not be aware or responsive to extreme weather changes. Tactile or touch sensation remains relatively intact, which is why touch and massage are activities used in late stages.
To determine pain you can refer to the dementia pain scale or watch for signs of pain. For example, if you witnessed a fall then assume there must be pain from the impact. If your loved one is protecting an arm or leg or winces when touched, that would be cause for investigation. If your loved one has a history of arthritis or broken bones, you can assume this causes pain. If there are weather changes, this can cause pain in the joints or at old fractures.
Breathing rapid short breaths, laying straight and stiff, or curled into a fetal position are all considered indicators of possible pain. Furrowed eyebrows or looking like one is in pain are signs and certainly crying out during movement indicate the presence of pain. Remember to treat the pain and be aware of the presence of pain, since your loved one may not be able to identify or alert others to his/her condition.
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Very helpful thread here. I've known about the lack of pain in Alzheimer's patients. I saw that frequently with my Alzheimer's patients. They would rip out IVs, pull on and tear out their foley catheters, try to stand on broken legs and hips, etc. . It was always mind boggling that they could do those things to themselves even knowing that the just didn't experience the pain the same way as a normal person.

But about the joint replacement patients: I also often had many totally lucid and mentally normal patients with new joints, who required very little pain medication. Invariably these patients stated that their bad knees (or hip, or shoulder, whatever) had hurt them so badly prior to the surgery, and the post op pain was so much less by comparison, that even without the drugs, it was huge improvement for their experience. So don't assume that not needing pain meds after this kind of surgery is necesarily due to the Alzheimers.

BTW, for TamCummingsMS, What I found so helpful in this thread is the info you offered about the increased taste for sweets. I've noticed this in my dad. He still does some shopping on his own, but if he comes home with two bags of groceries, the vast majority of it will be sweets. If he didn't go to the senior center for their 1$ lunch every day, he'd eat nothing else but bakery and ice cream. He probably eats 6 to 8 packages of Entennman's in a week. I was blaming it on the part of his dementia that leads ignore all the "shoulds" of life and to do only what he wants, when he wants. You know the "shoulds". An person should take a bath, should wash their hair, should chew with their mouth closed, should eat healthy foods, etc. He doesn't follow any "shoulds" any more. But now often leaves the meals I bring by to spoil in the fridge, even foods that used to be his favorites. The taste for only sugar would explain that. Thanks
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My Mom has vascular dementia and has severe arthritis. Before the dementia really set in she complained about the pain in her back and feet all the time. Now she rarely mentions having any pain. Most of the time she says nothing hurts. She does have a hernia the Dr. said he did not want to repair because of her age (91) from time to time she will complain of discomfort there but her complaints are short lived. She rarely says her back or feet hurt now. Which is worse, constant pain or no memory? I really don't know.
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The lack of pain is a blessing for the patient, but the caregiver must now be ultra alert for any changes with frequent body checks from head to toe, listen to lungs, take temps, watch for changes in urine or stool or even sweat glands. A visiting nurse once a week would be a good idea, ask the MD to recommend one.
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My MIL no longer complains of pain regularly. It used to be quite often. But I notice groaning, sighing, shallow rapid breathing. And her diet is mostly totally unhealthy foods. She's 88, lives along and fights the idea she may need any assistance. So when I see her I look for signs she may need to see the dr and alert my husband when it's time to have her looked at. Also hired a "companion" to check on her days we are not there and please alert us for any changes.
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My 92 year old mother with dementia had a mastectomy a week and a half ago. She seemed to feel very little pain from the tremendous incision! Her friends are amazed, as am I. She's complained more about her bad knee than the operation. And she's another one who's craving chocolates and bakery sweets. Then she says she doesn't really have a sweet tooth! Thank you all for the information.
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