My mom wakes up in severe pain with dementia. I have to try my best to give her pain meds. Why so much pain and what does this mean?

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Her pain is very real. Whether or not a cause for it is detectable is another matter.

When I was having pain from sciatica I was told to take the meds on a schedule, not to wait until the pain started. To stay ahead of the pain. And also to take the effective dose. Taking half as much as I needed was a waste of time and money.

This approach is how the nursing home finally got my mother's pain under control.

Dementia doesn't "cause" pain but it certainly can impact how we perceive pain -- that perception happens in the brain, after all.

I would address the pain. Work with her doctor or get a referral to a pain specialist. Experiment (under doctor's supervision) with various meds and doses until something works, and then follow that routine.

I was with my mother several times when the med tech came around to give her a pill. "What is this for?" "It is your afternoon pain pill." "But I don't have any pain." "That is because the pills we have for you are very effective. We don't want you to have pain!"
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Dementia is not painful. Is this only upon waking? Maybe she has bad arthritis and first getting up is painful. My Mom would complain about stomach pain but they never found anything. And when she did have some pain she over exaggerated it. Like a child, which in her mind she was. You have to be careful with pain meds. They have been shown to effect the liver. Call her doctor and see what he says.
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Karyll, what kind of pain? Who is prescribing these meds? Have you been in touch with the doctor to find out if there is a liquid form, or if the meds can be crushed and hidden in applesauce or pudding?

Is your mom having swallowing difficulties?
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