Expert: Michalene Peticca - 8/15/2008

Question
My mother has had alzheimer's for about 6 years. She was showing signs earlier. After she had a stroke, she was diagnose. She was living with me until June of this year. I was taking her to adult daycare. In June, she refused to walk. She was combative. I called an ambulance and they took her to emergency. She would yell in pain when anyone would grab or raise her legs. They did xrays and could not find any fractures. The Dr said that she has arthritis. She was sent to a nursing home for rehab. She was put into long term care because she refused to walk. She is in a recliner wheelchair. If I recline the chair she yells as if  in pain. If I raise her legs to put a pillow underneath her knees, she yells as if in pain. She fights the nurses when the put her in the bed. The roommate said that they grab her by her legs and under her arms.  She grabs anything nearby to hold onto. Her roommate said that once she is in the bed she yells out and moans during the night as if she is in pain.

I am just sick because I cannot help my mom. I will call her doctor tomorrow. I just don't know what to do.
They do have her on Tylenol as needed, but maybe they are not giving it if she cannot tell them she is in pain.

Thank you for any suggestions.  

Answer
Hello Barb,

Thank you so much for writing.  This question comes up occassionally, but i think it warrants much attention.

My experiences with Alzheimer's individuals is that, yes, they do have a heightened amount of pain.  This is a progressive, deterioration of the brain....which is bodily tissue.  Ever get a deep cut?  Didn't that hurt?   Unfortunately, because an individual like your mom cannot verbally express themselves due to the brain damage...they "act out" their hurt.

I am a strong advocate for pain medications vs. anti-psychotics..which rarely work because brain tissue has disappeared or is "dead" due to the disease, so what will the medication "adhere" to?  Unlike pain medications that are globally effective because they are focused on nerve endings in the body.

Yes, i would certainly suggest contacting the physician and requesting a Routine medication much stronger than Tylenol.  It appears that there is enough documentation that will support the need for her to have it.

I applaud your efforts to stay involved and get your mom the best care so she can be more comfortable.

Best Regards,

Michalene Peticca, MA