My mother cannot stand any kind of pain, does this happen with age?

My husband has dementia and is in a nursing home and I find he can't handle pain. There is no longer the ability to reason and understand what is happening and all they seem to be concerned with is their comfort.

Although my mother has always had a low threshold to pain, it's magnified 10,000 times now that she is older. When she broke her tailbone, you'd have thought someone was stabbing her repeatedly all over her body....ALL DAY. It was only when my brother asked her "Mom, do you have to do all that screaming?" that she finally squelched some of the noises.

As we progress in age the body changes considerably, pain increases everything seems to hurt and patience they have no longer will be there , try to comfort her in any way you can i know this can be hard i am a licensed home care nurse i see it all however family members have more difficulty understanding the aging process of a parent or loved one. sometime we have to take the bull by the rains if you know what i mean do not let them manipulate and control then u will find yourself in a whole different mess just let them know hey this is what it is and you have to work at it i pray her pain subsides

Yes, I believe that the in the elderly, tolerance for pain decreases. IMO, an elder in pain deserves not only pain relief measures via prescribed Rx or OTC analgesics, but also palliative measures like linament or heating pad. They also need our compassion. Many times they cannot adequately express the source of their pain, or they may exxagerate it due to a state of agitation (catch-22 there). In the case you describe, the dentist should have given your Mom an Rx for pain. With the elderly, the discomfort from the extractions may last longer than usual, and on top of that she has a "fabber" (temporary bridge?) on top of sore gums. The older we get, the longer it takes for us to heal. We will all be in their shoes some day. Please advocate for your mother's well-being and get her something for her pain.

My mom suffers greatly from osteo arthritis, but each day comes some new thing it seems and she will completely shut down and obsess over what is going on; whether it be a headache or constipation. She always went to the emergency room for minor things most would not go for, when she lived by herself.
Also has had many cosmetic surgeries, bariatric surgery,so she thinks a pill or surgery is the answer for anything.
I take care of her in my home, so it is difficult to see her obsessing over everything Sometimes just some pain that the doctor has said many times there is no complete answer for.
Another thing is her bowels. Put on laxatives at a young age, her intestines have become less efficient in and of themselves, so when she does not have a BM each day, she REALLY gets worried as old school taught that. Will shut down activities for that also and brood, obsess about it.
I'm assured most of her behavior is normal in elderly with dementia, but it can really drive one crazy sometimes, because their fears, altho unfounded usually, are VERY real to them.

There are neurological conditions that produce intense pain, which are often dismissed by physicians and civilians alike because they have either never seen it nor experienced it. My Mom screamed when I tried to cover her with a sheet. I mean screamed in agony. The Hospice nurse explained that nerve receptors were changing and any movement or motion would produce unbearable pain. Yes, some people with dementia scream a lot. But there is palliative care and it is cruel to make assumptions about another's pain. Soldiers on the battlefield have been known to shoot beloved comrades because of their pain. This is not a behavioral issue. This is human existence, look up the meaning of "compassion" and stop watching out for yourself only.

I am sure when she had work done she was told what to do and to take, i am aware of this pain in the gums and with dementia. continue to work with her, and with the dementia let her have her way and do as she pleases. seems thats the answer others would give i know this to well and all my clients are given love with restrictions and care. with all meds needed for pain i really do hope it all comes together for her sake..

My dad was always a very brave and determined man. At 89 yo I discovered he was claustrophobic and his tolerance for pain was greatly diminished. I do believe the natural increased frailty of the very elderly decreases their tolerance of pain. Even so, dad remained my brave hero.

It is hard to watch.

Best wishes

I don't think most people, especially caregivers, are "insensitive" to the pain of other people, I truly think most are unaware of the serious nature of pain.

I have been in the position of experiencing all three kinds of pain problems. OMG, you say, there are THREE KINDS? Yes, that has been my experience (and others may choose to add their own perception and interpretation) and here they are:

1) As a paramedical esthetician, I took care of many Plastic and Reconstructive post-procedure patients from full face lifts to nose jobs, from tummy tucks 2 liposuction. Tho the majority were elective surgeries, I can tell you there is still a lot of pain. Over and over again I witnessed the under medication of the patient by the doctor who was in my opinion relatively insensitive to the pain the patient was going through. With the doctor's experience, you would think they would know better. In the beginning with doctors who didn't know me, they actually thought I was exaggerating the patients pain. As they came to know me and realized that I was honestly advocating for the patients, the individual doctors started becoming more and more educated about the pain after effects of their surgeries, which they didn't seem to have understood from all the years of experience. Now, I ask you, if a doctor doesn't understand this, how can they participate in educating a caregiver? No, what happens is caregivers have to learn by trial and error, and unless they have prior experience with someone else, its on a case by case basis similar to reinventing the wheel each time.

2) I have also cared directly or indirectly for 8 people with different forms of dementia and one person with Lou Gehrig's disease (ALS). ALL have had pain in one form or another in different parts of their body and because of the nature of the dementia people being poor informants and the ALS man being unable to communicate, the pain was very frustrating to them. My mom who passed in January at 94-1/2 had severe osteoarthritis. Before her drug-induced dementia, she had had and ankle fusion, bilateral hip replacements and a knee replacement in addition to several eye surgeries and other dermatological surgeries. I just can we referred to her as Bionic and the truth was if she had not gotten to the age she was, she would have needed her other knee replaced as well as both of her shoulders. She was in severe pain all the time but she had hepatitis B and was unable to take NSAIDs, van had hallucinogenic reactions to vicodin, so she was put on darvocet, which undoubtedly contributed to her heart problem - atrial fibrillation - one of the reasons darvocet was completely removed from the market. My poor mom was in pain and driven to tears in many instances because of her shoulders. Many years before, she had opted not to have shoulder replacements because she said she didn't walk on her shoulders. Many yrs later, it appeared that that had been an ill-advised decision because her pain was excruciating and now all she had was tramadol an extra strength tylenol. It wasn't enough and her orthopedic doctor wanted to put her on morphine but my sister, my mom's health POA by subterfuge, who barely ever spent time around by mom or her pain, would not agree and managed to convince my moms PCP that it wasn't "the right thing". So my mom lived every day of her last 3 years in serious pain.

3) In my own case, I have what my doctor calls the worst fibromyalgia she's ever seen and in addition need double hip replacement. I have what is called a fixed deformity of my hips, so although I use a rolling Walker to get around, i leaving at a 30 degree angle and that puts a lot of pressure on my hands. In effect, I walk with my hands, and my hips and muscles hurt and every step is painful. I also have an incurable condition called venous insufficiency which, depending on the level of swelling in my legs, is painful either only be low the knee or sometimes including the knee and several inches up the thigh, making walking just that much more uncomfortable. If you're getting the idea that I have a lot of pain, you're on the right track. My condition has crept up and come on over a number of years, and I have learned to adapt and accommodate as best I can. I take tylenol codeine 4 because even the strongest vicodin or Norco isn't effective and my ortho says I'm probably going to have to move to oxycontin or morphine. Now that my mom passed away, I thought I would be moving directly into having my hip replacement surgery. There is a complication however in that doing one at a time will greatly compromise my rehabilitation but doing both together is not safe as my ortho tells me the mortality rate is not good for a double hip replacement. What to do, what to do? In the meantime I can explain to you that I deal with my pain and have it under control but if I do something as simple as slightly jam my tongue so into the wheel of my rollator, the pain produced is so exquisite that I burst into tears and can't get control of myself for 10 or 15 minutes. This is also true of any other small accidents that should not under normal circumstances produce the pain reaction that I have.

Please forgive me for being so long winded about this answer. Pain is very subjective and experiential. I have seen doctors and non caregiving visitors expressed the idea to a pain patient that, oh, it can't be that bad. But I take the same attitude that psychologists teach us when it comes to child molestation: if they say they've been molested, believe them. Identical for pain patients: if they say they're in pain, first of all believe them. More pain patients are telling the truth then not; they deserve sympathy and empathy and to have their complaint addressed and investigated.

I think we should assume that she's talking about pain that could more accurately be called 'discomfort' and that we can feel fairly confident is tolerable by a less compromised person.
I saw my father react as if he'd been punched when a nurse peeled a bandaid from a hairless part of his arm. When I look back, I consider his increasing intolerance to discomfort was one of the early signs of dementia.
To me, it's just one more way that dementia makes our parents more like large toddlers than adults. In fact it helps me to think of how I might respond if faced with some of the same behaviors from a child. It helps amp up my compassion. That said, it's aggravating to listen to whining whether it's coming from a 2 year-old or an 82 year-old.

so sorry, as you may have guessed I am NOT able to jam my TONGUE into the wheel of my rollator, I was trying to say TOE

My mother has always had hypochondria and ran to Doctors at each little twinge. It did seem to become worse when she started with dementia. There were times when she was at a Doctor's office 3 or 4 times a week. One, an orthopedist, "fired" her as a patient. She refused to take pain medication and wouldn't use the analgesic patches. Physical therapy helped a bit at first, but no real relief.The Dr. told her that there was nothing else he could do for her arthritic knees.
I got her a Medic Alert and she used it constantly. One week, she had the ambulance to her apartment 3 times. They transported only once.
I have noticed that as the dementia has progressed, she seems to have "forgotten" all of her aches and pains.

I have been the fulltime primary caregiver to both my parents (both live with me & husband) for past 7yrs. At 87yrs, my Dad has severe COPD, but no dementia, @ 83yrs, Mom has multiple serious health issues, & dementia. I was also caring for my older brother (who lived 20 mi from me) until he died from lung cancer a month ago. So needless to say, I was glad to find this website as I am burned out & need the LOVING support of other caregivers. So, it distresses me to read some of the comments made by people in response to answers given by other caregivers.

I have no idea what a "fabber" is, but having two teeth pulled will take time to heal, as I have had four removed. Being "old" is not an excuse for having pain. Have her see a neurologist or pain specialist to identify her threshold for pain. Pain is subjective, men having a greater tolerance for pain than women, but other illnesses could be causing the pain. Keep investigating and don't just treat the pain with pain meds. She will become addicted.

Our 86 year old cannot tolerate her hair being brushed for her no matter how gently,
she says it hurts, but she dries her hair an old way, back and forth, (instead of patting it) and then only wants to comb/brush the top strands, of her hair, as if she is finished.

All I have to say is if you never fell on your tailbone you do not know how it feels,
but I fell squarely on it and have had pain (3-4 years severely) in my tailbone whenever sitting or sleeping until now, that was in 2004.

Pain is a very individual matter in which fear and anxiety play a large role. it is necessary to understand the whole body and it's functions before the level of pain can be adequately estimated. The bottom line is that if the patient says they are in pain they have pain and they have the right to have it relieved. Healthcare professionals use what is called the pain scale which goes from one to ten. Ten being the worst possible pain the person can imagine. there are images that go with the scale and the face begins looking comfortable to screwed up in agony. I heard a pain expert recently describe the way pain medications should be calibrated and I hope I don't get this wrong. You first need to understand how long the drug takes on average to work given by different routes. So if you are giving it by mouth there is usually relief from a immediate relief med in about 30 minutes. If it is still just as bad when the 40 minute time is reached the original dose should be doubled and so on until the patient is pain free. Once the pain free stage is reached the dose can be gradually reduced or the interval extended until an acceptable (to the patient) level is reached . This does take a lot of experience and bedside observation. It is very important not to let pain get out of control because it takes much more medication to obtain relief. The focus should not be simply on the obvious cause of the pain but being aware of the whole person. Are they in an uncomfortable position, too hot, too cold, thirsty, is the bladder full do they need to empty their bowels. Have they developed infection in a wound. Applying heat or cold may help. Soaking in a bath or hot tub. gentle massage is good too. Soothing herbs such as lavender are calming and soft music. All of these things play a part in pain management. be careful with candles because the flicker can trigger migrains or seizures.
Pain management at this level can only be achieved with things like morphine because the meds like Vicoden and Tylenol #3 contain other compounds such as Tylenol or asprin and large doses of these cause other damage to the body.
Doctors tend to grossly under prescribe pain medication both from ignorance and fear of being seen as overprescribing narcotics. Oncologists are usually good as are hospice medical directors. I have no experience of pain management clinics. My experience has been that many elderly people in the general population not the dementias do tolerate a great deal of pain without complaint but others may not agree with that.. The moaning that many people do makes it difficult to assess but if you stop and listen carefully you may find that if it follows the respirations in the same rhythm it is just noise but if it is irregular it usually indicates pain and I stress this even in the unconscious patient close to death which is why it is necessary to continue at least a low dose. If they have been on narcotics for a period of time they can experience withdrawal symptoms. There are other things such as acupuncture, reflexology and hypnosis but I have no experience with those.
Experience and training are vital in managing and I would not expect a home health aide licensed or not to be responsible for assessing the level of pain. That is not to say such a person is not capable of doing so and making a patient comfortable, I just would not give them that responsibility
Dealing with agitation and restlessness and especially noise are extremely stressful in the home where often a single caregiver does the job alone 24/7 so it is important to seek any relief that can be provided.

May I share a comment I saw elsewhere, from a young person who has some chronic condition (maybe fibromylagia?). I have no nursing experience, just an ordinary woman finding herself dealing with an elderly husband with many problems.

She said, that for the caregiver, it's easy to shrug off some recurring, non life-threatening, problem -- but for the patient, each new moment of pain is fresh and new.

As new caregiver, I have this fault. My husband will suddenly jerk or grimace or just look very uncomfortable. I go "Oh, honey, what's the matter?"

He: "My phantom pain again."

Me, relieved. "Oh, that."

It's easy for me to dismiss something that for me is 'old news', non-threatening, nothing to do about it -- and get back to some chore or interesting problem.

Oh dear Flora,
Phantom pain is every bit as painful as every other pain often more so. Ask anyone who has had a limb amputated.

Candie, Your mother CAN stand pain if she went through labor and delivery. That is not to say she should suffer now, but did you check to see if she has developed "dry socket" where the teeth came out? The doctor who did the extractions should be able to check this and help her.

Dear Veronica, Thank you for your excellent commentary on pain assessment and medication management. I am not a nurse nor a health care professional, but caregiving for my mother over 15 years and watching the progression of her osteo arthritic and spine conditions made me very finely tuned to every nuance of her behavior. I learned all the signs and signals just as you described. We worked very closely with her pain management specialist and the procedure for the morphine dosages and timing were as you described. There were several times I had to bring her out of withdrawal-like symptons (writhing, jumping, twitching spasms) because due to her early dementia she would forget to take her medications for 24-36 hours, although she would swear to me that she took 'everything' she was supposed to and at the right time, when I would call to check on her and give her reminders. Keeping the pain at bay and under control is vitally important, and your comment "This does take a lot of experience and bedside observation. It is very important not to let pain get out of control because it takes much more medication to obtain relief" was so true. There were times I went to her after work, only to find that that she had taken no medicine all day, despite her assurances that she had taken 'everything'. I would then have to space out her pain meds over the rest of the evening, giving her a full dose, then just enough at intervals to bring relief until morning, when she coud resume her regular regimen. There were many times I had to sleep over, which was preferable to spending the night in the ER (although early on that is exactly what we had to do until I learned how to handle it myself). Thankfully she has been in the NH over one year, and I kept right on top of the NH doctor not to change her pain meds due to the fact that the regimen we achieved was keepiing her pain free. I can tell you that many times when she was hospitalized, doctors that did not know her history tried to change or reduce her meds with agonizing consequences for my Mom (at which point I read them the riot act). I think that is why when people downplay the 'reality' of an elderly person's pain experience, I go a little off the anger scale!

In response to the harsh answers regarding my mother's broken tailbone....
Mom REFUSED to see a doctor because she was so paranoid that we would have her committed. With that much paranoia, you would think she would have sense enough not to go to the front door, hang off the porch, and scream at the top of her lungs that she couldn't get her mail (which was just to the right of her) because -as she said- "broke her back." If the neighbors would have heard her, THEY would have reported her to authorities to have her psychologically evaluated.

I have no doubt that a broken tailbone hurts (I looked it up on the internet before making judgement on my mother's actions)....my point is that my mother screamed bloody murder even laying in the bed without moving for several minutes. In my childhood, she denied us the right to scream if we were in pain....I ask for the same consideration from an ADULT.

And as for being heartless......How would you feel if I told you my mother just had a MAJOR stroke 3 weeks ago and I have been her #1 advocate? Her doctor said Mom would never walk again and would probably never be able to talk or communicate again...and that the rest of her life would probably be spent in a nursing home. ****REALLY???**** I would not give up on that lady! I FOUGHT for her right to receive physical, occupational, and speech therapy. TODAY (just 3 weeks later), she walks, goes to the bathroom by herself, is feeding herself, uses the magnetic alphabet board that **I** made for her to spell words, and even uses a pencil & paper to write words. Her doctor thought I was crazy. I'm glad the therapy department at St Patrick's Hospital in Lake Charles, LA didn't think so. I'm so glad they believed Mom could do it!!!!

My mother suffered with arthritis for many years, but she never complained and kept going. A few years into her dementia, I too noticed that her tolerance for pain became less. In fact, as her dementia has progressed, all of her senses seem to be out of wack. Also, sometimes older people won't take pain medication because they are afraid of getting addicted, so it is hard to get their pain under control.

My answer was not harsh, but if your mother broke her tailbone, or even bruised her tailbone, she should have went to a hospital, for medical treatment, whether she wanted to go or not, because they are so excruciatingly painful.

Sometimes, it is best (for everybody concerned) if people we take care or get the medical treatment they need and deserve, that is why we are their caretakers.

Sometimes their decisions about themselves run into self-neglect, which even if they do it to themselves is still abuse, than to go along with their fears, which even if you agree or suspect there is some truth to it, all of that stuff is documented.

About your feelings of survival and PT, I have had three strokes, if not for determination to remain independent, I would have been in a nursing home unable to walk or talk and certainly not able to advocate for the rights of my 86 year old.

I did twelve years out get to make and walk across the stage of my own college graduation.

Never Underestimate the Nature of Human Will. Never Underestimate the Nature of the Human Mind.

To noGuilt... I hope your mother was given some good painkillers for the broken tailbone. Broke mine a long time ago and it was one of the most excruciating pains I've had and it didn't let up. I've had other really horrible pain but I digress. Was mis-diagnosed that it was bruised. Nope, snapped the sucker right off. I resorted to alcohol as pain management which you don't want to do. Desperate times, desperate measures. I eventually found a doctor who did a steroid injection in it which took care of it. You can't imagine the relief!

Paper lady, I too broke my tail bone as a teenager and the pain was very real and lasted many years when I sat down.

Hi Veronica. Yes. And I can pretty much guarantee that pain is gonna come back to haunt you again later. Old injuries like to come back and say "hey, remember me?". Not fondly.

Yeah. It takes some serious rationalizing and self-distracting mental power to power through pain. Folks with dementia are not going to be able to filter out fear and pain that way, and yeah, at the same time, they are more scared and immobilized under the circumstances. Mercy is one thing and pity is another - people in pain need medication and mercy, but not too much pity; most kinds of pain only get worse if they are allowed to immobilize you more than necessary. That's why rehab people have such a bad rep for being mean and heartless. :-)

I find that as I get older I cannot tolerate pain like I used to. I have been through a lot and most of it was beyond my control. Now I have pain in many areas and is hard to take.