Pain management


Positive clinical outcomes: transforming pain management


Based in the North West of England, Dovehaven Care Homes offers a wide range of care services for older adults specialising in residential and nursing care, with an emphasis on high-quality dementia and complex care. Jo Hadfield-Cubbin, head of clinical governance at Dovehaven Care Homes, describes the group’s use of a digital pain assessment tool and the role it has played in improving resident wellbeing by decreasing pain levels, particularly in those living with dementia


Here at Dovehaven, we have 23 care homes and have the responsibility of supporting 1,000 residents. Many of these residents are living with dementia, meaning pain management can often present challenges. This is because a person’s ability to reliably self-report their pain experience can decline as their dementia progresses and can at times manifest as distressed reaction behaviour. At Dovehaven, we wanted to test the hypothesis that distress – rather than being a ‘normal’ part of the dementia journey – was in fact pain related. With dementia high on our list of


strategic priorities, we decided that a better pain assessment and management solution was needed and so enlisted the support of a digital pain assessment tool to revitalise our pain procedures and processes. This opportunity was particularly significant for me, as I have always been driven by a personal career goal to support teams in enhancing pain management within social care settings. After qualifying as a Registered Nurse and working in social care for 30 years, I have now been afforded the opportunity to invest in this ambition at Dovehaven. Pain can profoundly affect an individual’s quality of life, so it is crucial to have consistent and reliable pain assessment and management procedures in place.


Pain in dementia


Pain management in elderly individuals with dementia is a significant challenge, as research consistently highlights poor outcomes related to both the inappropriate administration of analgesics and the failure to identify pain correctly. It is estimated that more than 50 per cent of people living in care homes experience persistent


July 2025 www.thecarehomeenvironment.com


or chronic pain. Moreover, those living with dementia are especially vulnerable to higher pain levels due to decreased mobility, which increases the risk of falls, accidents, and injuries. In addition to these challenges, many dementia patients in care settings also face age-related conditions such as osteoarthritis, pressure ulcers, skin tears, joint stiffness, muscle rigidity, and constipation, and other co-morbidities. Furthermore, behavioural and


psychological symptoms of dementia (BPSD) affect over 90 per cent of individuals with the condition. These symptoms can obscure the recognition of pain, leading to instances where pain goes unnoticed and untreated. This lack of appropriate pain management can contribute to the overuse or misuse of psychotropic medications, as pain-related distress may be attributed to psychological or behavioural issues rather than physical discomfort.


Despite the well-documented risks, benzodiazepines continue to be prescribed for a range of conditions, including the management of neuropsychiatric symptoms associated with dementia. However, we understand that, whenever possible, these medications should be avoided in older adults, as they are linked to a variety of harmful side effects. Notably, benzodiazepines are associated with an increased risk of falls and fall- related fractures, which can have severe consequences for the elderly. Additionally, their use is linked to accelerated cognitive decline in individuals living with dementia, further compromising quality of life. Research from the National Library of suggests that benzodiazepines


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may also increase the risk of pneumonia and suppress immune function, which can make older individuals more vulnerable to infections. Combined, these adverse effects


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