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My mother has always had a very high tolerance for pain. No novocain needed at dentist no matter what they were doing, etc. She is now 86 and seems even more impervious to pain. She fell Friday night and cut her arm badly on the end of the basket handle of her rollater. She insisted she was fine despite the blood dripping on the floor and the fact that she couldn't get up. I ignored her protests and called 911. They took her to the ER where the doctor said he couldn't believe she wasn't screaming in pain. She said it didn't hurt. He applied numbing medicine anyway. Apparently the cut went almost to the bone plus several inches of torn skin. It took him an hour to sew up the inside of her arm. The skin was too thin to hold stitches. and they were unable to pull it together. Home at 2:30 am. BTW, She kept asking me why she was there. She didn't remember the fall or the ambulance. Back to urgent care Sat. because she was bleeding through the bandages (but it still didn't hurt). Only wound care appointment before next week is Thurs at 8am. That will be fun since she doesn't usually get up until 1 pm. Meanwhile, I am dealing with the bandages since the open wounds keep seeping. In addition to current situation, I'm worried about how to tell when she is ok or not ok? Is this high pain tolerance common? How do we deal with it?

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My mom has dementia and she does feel pain , she has osteoarthritis, hx of bil dvts in her legs , back pain and other issues ..she does not  verbalize it well but she becomes angry and she grimaces and I ask her mom are you in pain and she says no ,but being a RN I can tell she is in severe pain , which causes her increased anxiety and so I give her a pain pill and she is back to her happy self ,,,,people with dementia cannot express pain , sometimes don’t even show pain because their brain doesn’t work well enough to put pain and expression together..at work I always give my dementia patients their pain meds when they grimace or look uncomfortable,,,so yes they still have pain but maybe cannot tell you ..
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No, it doesn't.
PLWD can feel pain but they cannot identify, describe nor isolate it. They can say "I am fine", but you can see that their behavior changes. And this change can be extreme - aggression, anxiety, pacing OR they withdraw completely.

There is a huge misunderstanding in the world about feeling pain in dementia. Instead of being given pain killers, they get antipsychotic medication. Because we see aggression as dementia symptom, whereas the reason for aggression is untreated pain.
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It is an eye opening knowledge.
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In many cases you have to go by other clues to determine if the person is feeling pain.
My Husband had a very high pain threshold for as long as I knew him.
My biggest problem was he became pretty much non verbal very early on in his diagnosis so I had to look for facial clues, a grimace or furrowing of his brow to determine pain. But often that did not work either.
I think what happens may be two fold.
The pain is constant so a particular level of pain then becomes "normal" that combined with the brains inability to express in words the pain. And I think since the "wiring in the brain" is short circuiting anyway the misfires may not transmit to the pain receptors.

I think many people with chronic pain become so used to the pain that they would not know what "no pain" would feel like any more.
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I think that sometimes long term use of strong pain meds is more about addiction than actual pain, so it makes sense that once they are weaned off they are no longer needed.

I also think that many of the very old are so used to experiencing generalized, chronic pain that they just accept it in the same way they accept the other infirmities the now live with. It doesn't mean they couldn't feel better without regularly scheduled pain medication though.

And finally, I know my mom is unable to articulate when and where she has pain, so when she seems "off" it takes some investigating to try to figure out what the problem is. And since she isn't on anything stronger than tylenol the nurses tend to dismiss her pain as minor rather than take it seriously, I think poor mom just survives in a near constant low level of misery.
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Some people are born without the ability to feel pain--here's the wikipedia link:

wikipedia.org/wiki/Congenital_insensitivity_to_pain

Some medical papers say people with dementia become more aggressive when they are in pain, or they may become even more sensitive or lose the words to describe pain.
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Grandma1954 - Yes, and you become used to the pain and you live with it. But you are anxious all the time as well. And people think this is normal for you. But there are days when you are much "softer" - not because you are having a good day, but because you are pain free.

There can be head pain, bone pain, joint pain, meds pain, wrong shoes, trousers, diapers, hair etc. Thousands of reasons. There can be a spiritual pain as well. They do feel pain - but we are so focused on dementia symptoms, that we do not read the signals, they send to us. We need a new approach to dementia care.
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My mom has dementia. She would not verbally express pain.  She would become aggressive when being cared for and often grimaced. Once she got on routine pain meds, she became cooperative and is walking better and sleeping more. The other thing she did when she was in pain was stop and put her hand on her hip when we walked. So I believe she was having hip or back pain.
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My mom had a ton of dental work done recently- teeth pulled, root canals etc and not only did she not remember any of it, she never complained of pain. We gave her Tylenol in case she really was in pain but she would say there was not much pain. Maybe their receptors diminish as the dementia progresses
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Seems like that's the case with my mom. She was basically addicted to narcotics for 50 years and when she turned about 80, her Dr wouldn't give her anything opioid related for pain. Weirdly enough, as she's progressing through dementia, she really doesn't complain of pain.
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Thank you marmey you said it perfectly ,,, I agree 100% ...thank you ,,,
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