When cognitively impaired patients are in pain, they may be unable to verbalize it, and in the presence of ongoing agitation, family and caregivers may not recognize it. Facial clues to pain are a good proxy for self-reported pain, but studies indicate that clinicians are no better at reading these signs than nonprofessional caregivers. This suggests that nurses who work with these patients need special training to decode facial expressions signifying pain. 

Patients with dementia are susceptible to the same broad range of chronic degenerative and progressive medical conditions associated with aging in the general population. So more information than just the expression of pain is important for appropriate diagnosis and treatment. Behavioral changes are often interpreted as a feature of cognitive impairment (CI) but may instead point to a new or intensified experience of physical discomfort. Nurses should take special care to monitor their patients with dementia for even small changes in daily habits, speech, facial expressions, or mood.

Pain management in individuals with CI is often inadequate; these patients receive analgesic prescriptions at significantly lower rates than healthy populations. Undertreatment or lack of pain management in these individuals can have serious physical and psychological consequences. When prescribing for pain, NPs must carefully consider the patient’s ability to manage medications while providing pain relief appropriately. Patients with dementia generally express pain intensity through facial expressions as efficiently as non-demented individuals, so nurses who have learned to read these expressions properly will be able to recognize when pain management is successful.