Pain management: Dignity in care videos

What is the video about?

This film reminds us that pain levels vary for every individual. It says that medication is important but that it isn’t always appropriate and sometimes it shouldn’t be a first step. The film also looks at how alternative therapies, massages and the simple use of moisturiser to keep the skin hydrated, can make a big difference in alleviating some of the pain that people have. Paul is featured having Reiki treatment at St Cuthbert’s hospice, Durham, to support him with his Parkinson’s; on the film he says 'it’s like “magic”' because the Reiki makes him feel relaxed and stable. The film also looks at how it’s important to communicate properly so that people with, for instance, dementia and learning disabilities, can be supported to tell staff how they are dealing with any pain issues they have.

• Video transcript Open

  Words on screen: title

  Dignity in care: pain management

  VO/words on screen

  Pain management is important to people’s quality of life.

  Care staff need to know when people are in pain and how to respond.

  William Ovington, St Cuthbert’s Hospice Durham

  When I first got the pain before the morphine you gave a score out of 10, what I had was 9. Really hard, sharp, fierce jabs of pain.

  VO/words on screen

  People may not always report pain.

  Alison Cowen

  I would certainly encourage Tom to say if he was in pain but at the same time recognising that his idea of pain is probably very different to mine and that he might not express that he’s in pain until he’s in very severe pain.

  Anita Astle, Managing Director, Wren Hall Nursing Home

  Pain’s one of those things that can really make people feel miserable, totally disinterested, not want to be involved in anything and actually if you alleviate the pain you actually lift people’s moods, you make them feel so much better and they’ll get far more involved in what’s around them.

  People express pain in many different ways because there’s so many different types of pain that people can experience. We need to understand what those different forms of pain are, so it might be emotional pain, it might be physical pain it might be a sense of loss, so some people can tell us; ‘my arm hurts’, ‘my leg hurts’, but equally, some people can’t tell us so then we’ve got to pick up on what’s happening with that person to identify that they are experiencing pain.

  It may be that they wince when they move, it may be that they are constantly rubbing an area, it’s all those subtle things that we have to be very aware of so that we can then take the appropriate action.

  You’ll see various things like hand massage, foot massage, you’ll also see things like physiotherapy, so that can alleviate pain when it’s related to joint strictures and contractures. Obviously there’s always medication and frequently we look at giving people medication such as Paracetamol to alleviate any physical pain.

  VO/words on screen

  No one should have to live with pain as medication is available.

  Pain relief medication should be regularly reviewed.

  People with dementia may not be able to tell you that they’re in pain.

  Jack and Margaret Fowler

  I can just look at Jack and know there’s something wrong with him, I can just know by looking at his face, I can tell.

  Jack

  Well I suppose...

  Margaret

  I can tell

  Jack

  You get used to people you know all the do’s and don’ts and what their habits are, so if these habits slightly change, even if it just a slight difference.

  Margaret

  When he is in pain, he does look different, he looks completely different

  Jack

  Do I look vacant? (laughs)

  Margaret

  No you don’t look vacant, he just has this like, worried look on his face, you know.

  Sharron Tolman, Admiral Nurse, St Cuthbert’s Hospice Durham

  Well when people have dementia, particularly when dementia progresses, they have difficulty expressing pain, so they may still feel the sensation of pain, but have difficulty expressing it and its therefore under recognised and under treated.

  So we’re off to visit Margaret and Jack and today I want to talk to Jack about how he is, how things are generally for him and how he’s coping in terms of any pain or distress that he might be feeling.

  With people’s dementia, truly understanding a person is very important.

  Good afternoon.

  Jack

  Come in!

  Sharron Tolman

  Does pain cause you to get angry sometimes or frustrated?

  Jack Fowler

  No, no, not with that...

  Margaret Fowler

  Yes, you do

  Jack Fowler

  I don’t, I don’t get, I don’t shout and jump about.

  Margaret Fowler

  Oh you don’t shout, but you get quite annoyed, you get angry with yourself.

  Jack Fowler

  I’ve got arthritis, early stages of arthritis, the longer you sit and do nothing the pain seems to increase, where if you get up and walk about, you’re moving all your muscles, your bone ends are wriggling about and it stops the pain, so really it’s a case of getting out and doing exercise to keep the arthritis away.

  Margaret Fowler

  And I mean sometimes on a morning he can hardly walk when he gets out of bed, but he says once he’s walked for his paper, and come back...

  Jack Fowler

  It’s just exercise really...

  Margaret Fowler

  It gets better.

  Jack Fowler

  With walking for me papers and exercise, when I come back I’m ok.

  VO/words on screen

  Support may be needed to remind people to take medication.

  Sharron Tolman

  In early stages of dementia the person may be able to express verbally if they are experiencing pain and seek medication for that if that’s going to help. We need to be mindful that someone may forget to take medication in an early stage, or they may take medication and then take medication again because and they’ve forgotten they’ve already taken it. Medication management is very important in early dementia.

  Jack Fowler

  You forget, it just doesn’t enter your head and without Margaret prompting me things just don’t get done and mainly me tablets.

  Margaret Fowler

  And everything else in your life!

  Jack Fowler

  You would think like after a few days ‘I’ve got to take me tablets every morning’, but it just doesn’t enter your head.

  Margaret Fowler

  (Laughing) He said to me yesterday...

  Jack Fowler

  She said to me, ‘have you took your tablets?’, I said ‘no’ and this was just after eleven o’clock and I was supposed to take them somewhere between nine and ten.

  Sharron Tolman

  It’s important to take medication for pain as prescribed but it’s also important to keep it under review. When you’re trying to support people with pain use comfort measures in terms of massage, touch, we can use baths as a nice form of relaxation, warm water. If someone with dementia has pain and it’s not treated or considered, it can have a significant impact on their whole wellbeing.

  Tom’s PA

  Gonna lock the door?

  Tom Cowen

  Yes

  Alison Cowen, Tom’s Mum

  Tom’s generally very active so he does things like gardening and conservation work, but he also has just recently started going to the gym which he really enjoys.

  Tom’s PA

  Right, so...

  Alison Cowen

  Exercise can generally make you feel much better about yourself and its equally important for any of us as it is for Tom.

  Tom has an incredibly high pain threshold and so it’s not something that he would verbalise.

  Tom’s PA

  So Tom, what happened yesterday, did you fall off the horse?

  Tom

  Yes

  Tom's PA

  And what did you do?

  Tom

  I don’t know, I don’t know.

  Alison Cowen

  So it’s more a question of people looking for the tell-tale signs, like hand on the shoulder or if he has a migraine he might go off to his room, hold his head in his hands so that requires a response from other people ‘Tom, have you got a headache, do you need a tablet?’, it’s very important that there’s a record of things that have happened or things that are important for all members of the team to know about a person and its exactly these sorts of things that are likely to come out.

  Tom’s PA

  Tell me whereabouts it hurts.

  Alison Cowen

  I guess the most important things for people who are supporting someone to manage pain is that they know the person really well, especially if the person doesn’t express pain, they know what the signs might be, that somebody might be in pain, so that they can hopefully do something about it.

  Tom’s PA

  Does it hurt anywhere else?

  Tom

  No.

  VO/words on screen

  Many people find respite from pain and discomfort through alternative therapies.

  Julie Brown, Staff Nurse, St Cuthbert’s Hospice Durham

  Pain is very powerful and the level of pain is personal, pain is what a person says it is. I’ve heard the most important thing is actually knowing the person and to nurture a sense of trust with that person.

  Paul’s medical conditions mean that he presents with many involuntary movements and he copes amazingly well with all that.

  When Paul has Reiki then he is very still and he has described period of just beautiful relaxation.

  Paul, St Cuthbert’s Hospice

  Normally I can’t keep myself very still because I’ve got Parkinson’s, advanced Parkinson’s, I’m trying all sorts of different treatments but half of it is when you relax, when I come to here, this is like magic.

  Julie Brown

  If a person has a particularly strong relationship either with their GP or their District Nurse then in coming here it’s important that they know that we communicate and work with them.

  (Alarm sounds)

  From a management point of view, if a drug has been designed for regular dosage, for example if a person has Parkinson’s disease, then their drug regime may dictate that for optimum effect that they are taken regularly. If a person can achieve a tolerable level of pain, for example, if they have Cancer, they can begin to feel whole again.

  William Ovington, St Cuthbert’s Hospice Durham

  I came back today and before that I was down in the dumps, completely, utterly, down there, then I didn’t want to do anything didn’t want to talk, didn’t want nothing.

  After the initial shock of getting the fingers and everything, the little pains, there starts a nice glows goes up, wherever the pain was it seems to go away as well. It really helps, a nice warm glow is the way I describe it but when you come in from the winter’s cold you have a nice cup of whatever, you know, it really helps, the swelling’s down and I can get me shoes on again. I honestly think a lot is in the mind and it’s up here, it’s not anywhere else and you need alternatives somewhere.

  Oh I do the art, I was absolutely useless at art, completely, but Edmund is the instructor, he taught us how to look at things differently. Well, you forget all about the pain because you’re too busy engrossed and I really get lost in it.

  Julie Brown

  Pain management is all about holistic support and just helping people to be who they are for as long as can be.

  William Ovington

  I try anything to get it out of your head because eighty percent of it is up here, get the pain out of your head.

  Title: Key Learning Points

  Living with pain is not an inevitable part of the ageing process – medication can help

  People with communication problems can’t always let someone know when they are in pain

  It is important that care staff are able to spot non-verbal signs that someone is in pain

  There are many non-medical responses that can help relieve pain

  END

Who will find this useful?

Care staff, managers, GPs, nurses, commissioners, people who use services and their family carers or friends who are carers.