Undertreated Pain Plagues Alzheimer's Patients Who Hurt, but Can't Tell.

Sept. 22, 2006 -- Alzheimer's patients feel pain -- but because it's hard for them to tell anyone about it, their pain is undertreated.

That might seem obvious. But there's been an assumption that Alzheimer's patients can't feel pain as sharply as can other aging adults. That assumption plays out in practice: Alzheimer's patients receive painkillers less often than their peers do.

Now an Australian study provides powerful evidence that Alzheimer's patients feel pain as powerfully as others -- if not more so.

"Pain perception and processing are not diminished in Alzheimer's diseaseAlzheimer's disease, thereby raising concerns about the current inadequate treatment of pain in this highly dependent and vulnerable patient group," conclude Leonie J. Cole and colleagues at the University of Melbourne and the National Ageing Research Institute, Parkville, Victoria, Australia.

Brains Tell What Patients Can't

Cole and colleagues studied 14 patients with mild-to-moderate Alzheimer's disease and 15 age-matched volunteers without Alzheimer's. All study subjects underwent a test in which a device pressed their thumbs until they felt just noticeable pain, weak pain, and moderate pain.

During this test, the researchers used a real-time brain scan -- functional magnetic resonance imaging (fMRI) -- to look for activity in the brain's major pain channels.

Pain activity in the brain was just as strong in the Alzheimer's patients as in the healthy volunteers. In fact, pain activity lasted longer in the Alzheimer's patients.

This, Cole and colleagues suggest, means that the patients were less able than healthy people to turn their attention away from the pain. Less able to put the pain into the context of their experience, they found the pain more distressing.

And these were patients still able to communicate. Pain may be even more bewildering to more severely affected patients.

"The experience of pain may be more distressing for these patients on account of their impaired ability to accurately appraise the unpleasant sensation and its future implications," Cole and colleagues suggest.

Their study appears in the advance online edition of the journal Brain.

Pain in alzheimers patients can be very hard to define. some get really mad and combative with the caregiver pain meds I have experenced can calm the patient I believe this should be tried as well as the phyco drugs given to make vombies out of them. I have worked with many and I would like to see pain meds tried frist they have done wonders for many patients. Alzheimers patients do feel pain. the ones that have little or no pain are the ones that the disease has distroyed that part of the brain. It is very easy to tell the ones that feel little or no pain will pick up a hot cup of coffee and down it like nothing at all. not all alzheimers patients are the same and should not be treated as they are.