April 3, 2026 • 23 mins
What if the “behavior problems” we see in people living with dementia are actually signs of pain?
Host Dana Rampolla speaks with Barbara Resnick, PhD, RN, CRNP, FAAN, FAANP, Distinguished University Professor and associate dean of research at the University of Maryland School of Nursing who is an expert in aging and long-term care, about how pain often goes unrecognized in people with dementia. Because they may struggle to communicate discomfort, pain can show up as agitation, withdrawal, resistance to care, or sudden changes in appetite and engagement. These behaviors are sometimes misunderstood and treated with sedating medications instead of addressing the root cause.
Resnick explains what caregivers and clinicians should watch for, from facial expressions and lashing out to subtle shifts in participation and mood.
Health care professionals can learn more about pain management in long-term care settings in this Clinical Practice Guide co-authored by Resnick: https://www.jamda.com/article/S1525-8610(21)00911-7/fulltext
Chapters
00:00 Pain Without Words
00:28 Meet Dr. Resnick
02:36 Why Pain Gets Missed
06:15 The Vicious Cycle
07:28 Signs to Watch For
08:55 Find the Root Cause
10:40 Guidelines in Nursing Homes
11:37 Non-Drug Pain Relief
15:36 Questions for Care Teams
17:30 Key Takeaways
19:06 Why She Does This Work
20:55 NIH Study in Practice
22:56 Closing Credits
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dana Rampoll (00:00):
When someone is in pain, we usually expect them to
say, so just tell me what's wrong.
But sometimes they can't do that.
And what happens when they can't?
For people living with dementia,pain doesn't always show up
the way we expect either.
Instead of saying, this hurts.
Someone might become agitated, theymight become withdrawn or even resistant
(00:20):
to care, and those behaviors caneasily be mistaken for something else.
And then when that happens,the pain can go untreated.
Our guest today is working to change that.
Dr. Barbara Resnick is a professor atthe University of Maryland School of
Nursing and an internationally recognizedexpert in aging and long-term care.
Her research supported by the NationalInstitutes of Health focuses on
(00:44):
improving quality of life for olderadults, and that includes helping
nursing home staff better recognizeand manage pain in
residents with dementia.
Her work is helping caregiverslook beyond behavior, identify
root causes of discomfort, and usesafer approaches to relieve pain.
Sometimes without relying onmedications, that can also
(01:06):
increase confusion and fall risk.
Join me as I chat with Dr. BarbaraResnick about what pain really
looks like in people with dementiaand how recognizing it differently
could dramatically improve care.
I'm Dana Rampolla andthis is the UMB Pulse.
Jena Frick (01:26):
You are listening to the heartbeat of the University of
Maryland, Baltimore, the UMB Pulse.
Dana Rampolla (01:44):
Dr. Resnick.
Thank you so much for joining ustoday on the UMB Pulse Podcast.
Barbara Resnick (01:50):
It's a pleasure to be here.
Thank you.
Dana (01:53):
We are excited to welcome you on the UMB Pulse today because you are
also featured in our Breakthroughs Can'tWait campaign, which is a communications
campaign we've been running for sometime here at the University of Maryland
Baltimore, featuring researchers andwhy research matters, why funding for
research matters, and I personally findyour topic of research so interesting.
(02:16):
Just to jump right in, you were.
Researching why, um, and how peoplereact to pain, especially when
there are people who are going,you know, experiencing dementia.
So let's talk a little bit abouthow that's why that's important and
why it's not always straightforward.
(02:36):
Oftentimes people with dementia maynot be able to communicate to us what's
going on when we're used to hearingsomebody just simply say, it hurts, or,
I have pain in my knee, can you help me?
So how does this affect.
People who aren't able to explainthings in such simple words.
Barbara R (02:54):
So first of all, it's critically important because it's so often
missed and you're absolutely correct.
Um, many times it's missed becausepeople can't communicate it.
There's also an assumption thateverybody older has pain, so no big deal.
So I just ignore it.
So there is that issue.
(03:17):
Um, but the other really concerning thing.
About pain and people living withdementia is they express it in ways
that get interpreted as other problems.
For example, if you are impaired,you can't express the pain, but
(03:38):
it hurts, what would you do?
You're going to hit somebody ifthey move a joint and then it hurts.
The reaction is to go like that.
And so it often gets interpretedas behavioral symptoms.
It gets treated maybe as a behavioralsymptom rather than looking for the
(03:59):
underlying cause of the pain and treatingthat or treating the pain appropriately.
Dana Rampolla (04:06):
Well, and you've spent a lot of time studying this.
Was there a moment in your work when yourealized just how often people who have
dementia ex their, their pain experiencesbeing missed the way you just described?
Barbara Resnick (04:18):
Yeah.
Well, it, it's hard to.
Tell that for sure because we wouldhave to do some additional testing to
really know, but I would say it's atleast 50% and it's really interesting.
If you look at studies about painand people living with dementia, the
percentage of pain runs anywhere from 9%.
(04:42):
To 88% of people being in pain.
Now, these are different samples, butstill you see that big range really
raises concerns, and I have found in myown work that pain is not recognized.
Not documented.
Not assessed, and not managed.
Dana Ram (05:05):
And you just mentioned how behaviors like being irritable
or hitting someone can be signsof pain, and that's something that
people may not think of immediately.
Why do you think those signalsget misunderstood so often?
Barbara R (05:19):
Well, because they're often considered as signs of dementia.
They're called behavioralsymptoms associated with dementia.
Sometimes other terms are used.
And so it's not unusual tosee that behavior just happen.
Uh, maybe, I mean,think about it yourself.
(05:40):
Even if you're not having pain,somebody came and started taking your
clothes off, you might resist them.
You might hit them.
It could be pain 'cause it hurts whenyou got moved, but it also could just be,
uh, confused with a behavioral symptom.
So it is hard to differentiate versuswhen somebody just out and out says,
(06:02):
I have pain in my arm or my shoulder.
When you move it
Dana Rampolla (06:07):
right,
Barbara Resnick (06:07):
stop.
We're so lucky, right?
We're not so lucky when working withpeople who are living with dementia.
Dana R (06:15):
And when that pain isn't recognized in a person with dementia,
what can that mean for their day-to-dayhealth and their quality of life?
Barbara Resn (06:23):
Well, it certainly decreases anybody's quality of life
when you're hurt, but it also becomes avicious cycle where somebody's in pain,
they move less, there's less function, acurrent, a continual decline in function.
More pain.
(06:43):
And the other thing we can see ismore behavioral symptoms, which is
really a concern because then yougo down this other path of people
trying to treat behavioral symptoms,which may be with drugs that are
sedating and uh, other problems.
Dana Rampolla (07:00):
And
Barbara Resnick (07:00):
then it
Dana Ramp (07:01):
cause other problems.
Barbara Resnick (07:02):
Right?
Exactly.
Exactly.
Dana Rampolla (07:05):
Hmm.
I think back when I was in college,my grandmother lived with us
for a, a long period of time.
She had Alzheimer's and then shewound up, you know, for the end of
her life, being in a nursing home.
And it makes me a little nervous becauseI wonder if we understood some of the
signs that maybe she was exhibiting thatshe could have been in pain when we just
(07:26):
took it for the way you just described.
So what, what are signs thatyou would tell people to look
for if they have a loved one?
Barbara Resnick (07:34):
So some things that we commonly see.
First of all, it's facial expressionsand everybody's really a little
different, but when you have pain,your face does something usually.
So facial expressions and notignoring them are really important.
Um, iveness to care is avery common response to pain.
(07:59):
What would anyone do?
It hurts.
I'm gonna lash out at you,or I'm gonna pull back.
Oh.
Um, some things might be, uh, hitting,kicking, biting, screaming, those types
of things, particularly when they'reassociated with maybe a movement
versus the person just lying there.
(08:22):
Some people withdraw into themselveswhen they have pain to cope, so it
might be just curled up in a ball.
If you touch the person, you'llsee some of those other, they
might again hit lash out.
You can see a decrease inappetite, decrease willingness
to engage in any activities.
(08:44):
All of those could besigns and symptoms of pain.
Dana Rampolla (08:49):
Wow.
There are lots of different thingsto look for and it's hard when
someone can't really explain.
And one thing that stood out to me inyour research is that sometimes the
cause of the pain could be somethingvery simple, like their nails being too
long is an irritant to them, or maybethey have a small physical discomfort
that isn't necessarily a pain reaction.
(09:10):
So why is identifying the root causesuch an important part of the process?
Barbara Res (09:15):
Well, first of all, this is probably one of the biggest
mixed missed activities around pain.
It is not assessed comprehensively anddiagnosed and the underlying treatment.
Doesn't happen.
If you treat the underlying problem,you're gonna help the pain without
giving the person drugs or, I mean,non-pharmacological interventions are
(09:41):
terrific, but they also take time.
It might not be necessary if youcut the nails that are hurting.
Um, if you identify, sometimesit's a pressure sore.
The person might be able to even pointto the area, but nobody noted it.
Nobody found it.
Sometimes it may be a reallyimportant acute problem.
(10:03):
Um, so looking for that causeis critical, but it requires a
comprehensive, really, history issometimes hard to get in these people,
but you could do a comprehensive exam.
And identify the pain.
The majority of the painis often positioning.
(10:25):
If you lay with your head like thisor like this and just repositioning,
people can make a difference.
So it's critical to lookfor that cause at least.
Dana Ramp (10:39):
That's a great point.
And you're helping nursing homesput updated national pain management
guidelines into place, correct?
Barbara Resnick (10:46):
Correct.
Dana Ra (10:48):
And in in simple terms, what are those guidelines encouraging
caregivers to maybe do differently?
You said to give a comprehensive report,but what specifically would that mean?
Barbara Resnic (10:57):
So it, it really takes the approach of assessing people
for pain, looking for the underlyingproblem, treating the underlying
problem, and treating the pain firstwith non-pharmacological interventions.
And then if those do not alleviatethe pain, then adding pharmacological
(11:19):
appropriate pharmacological interventions.
And so we use a lot of.
Innovative non-pharmacological approaches,particularly in people wi living with
dementia because the pharmacologic agentscan cause significant side effects.
Dana Ramp (11:37):
So is that an example that you just gave where maybe you
would try to turn someone over orsit them up, something like that?
Or are there other types of things?
Barbara Resnick (11:46):
Absolutely.
Positioning and physical activity.
Are probably our most common and mosteffective non-pharmacological approaches.
And think about it yourself.
If you have flu and you lay in bed for aday, you ache like heck when you get up?
How do you think it feels dayafter day for these people lying
(12:08):
in bed Positioning is critical.
So we do do a lot of that to helprelieve really vague kind of chronic
pain, but it can be bothersome.
Um, and then there's many othernon-pharmacological approaches.
We use everything from heat, ice, um,distraction is a really big one as well.
(12:34):
And other, other techniques.
Dana Rampo (12:38):
Barbara, I feel that way sitting in my chair all day.
Exactly.
I think I need to changeposition or get an ice pack.
Barbara Resnick (12:46):
Get up.
No.
Get up and take a walk.
Dana Rampolla (12:48):
Right, right.
Barbara (12:49):
Get up and take a walk.
Dana Ra (12:51):
if we can get people to widely adopt these, these guidelines
and these um, actions, do you thinkthat it will change the care experience
for someone living with dementia?
Barbara R (13:02):
I think it can make a major difference and as we, um, implement
the guidelines, we're not asking staffto do anything that they shouldn't be
doing already or anything that can't,uh, be incorporated into routine care.
So it's not hard to do these.
(13:23):
And these are all really things thatare required in nursing home care.
Based on, um, state andfederal requirements.
Dana Rampo (13:35):
Another thing that I remember reading you mentioning, just
going back to the non-invasive type,um, care you had talked about, like
having conversations with, with peoplemaybe bringing up happy memories.
If they ha if they have the abilityto recall, say from the past,
do you think that can actuallybe a simple way to help someone?
(13:58):
You know, kind of focus on somethingdifferent, like kind of like moving their
body, moving their brain a little bit too.
Barbara Resnick (14:04):
Well, it's distraction is great.
And what do we all do when we have pain?
You try and distract yourself.
You'll read a book, you listento a book you watch, tell
you do something to distract.
So those conversations.
Can be distracting.
They take your mind off the pain.
(14:26):
The other thing that's veryinteresting from a physiological
perspective is even just being kind,which is part of that conversation.
It's a more positive care interaction andbeing kind causes a change in our brains
(14:47):
and the neuro neurological circuitry.
So that it actually decreases pain.
So that's another but more, it gets intosome of the physiological reasons why
this works, but it works and it doesn'ttake a staff member any more time to be
(15:08):
kind when you're working with somebody.
Just talking with them and distractingthem can help you get through that bath.
Without causing pain versus justapproaching somebody and moving joints.
That hurt.
Dana (15:24):
Yeah, I completely agree.
Um, just letting them feel like theymatter and that you care about what
they're saying, even if they're tellingyou that story for the 10th time.
Barbara Resnick (15:35):
Mm-hmm.
Dana Ramp (15:36):
For someone listening who has a parent or maybe a grandparent
in long-term care, is there a questionthat they should be asking caregivers
when it comes to pain management?
Barbara Resnick (15:46):
I, I think it's asking a, number one, have they
seen any indication of pain?
It just raises the issue, you know?
Have you seen, my momtends to, uh, do this.
If she has pain, she'll bring upher legs and curl up into a ball.
They, they can ask about that.
(16:06):
Um, and then I think it's alwaysimportant to ask about, have
you been getting mom outta bed?
Um, moving, depending on what,hi mom or dad's or whoever's
underlying capability is, if theycan walk, have they been walking?
You know, just finding out.
If they've been doing those things or ifthere's any change in behavior because
(16:31):
change in behavior might indicate pain.
Also, things like, you know,are they eating as they used to?
Are they going to activities,those types of things.
Dana Rampoll (16:43):
And what about for the person who may be a caregiver
still in the home for a loved one?
Can they do anything that wouldmake a big difference in the
comfort or the same types of things?
Barbara Resnick (16:52):
I, I would say it's the same types of things.
Of course, they have theopportunity of knowing that person.
Even better.
And so they should, because they're onlytaking care of one person, hopefully.
Um, and even you see the samething in small assisted livings
because you, you really get toknow that small group of patients.
So you're looking for changes, facialexpressions, but changes in behavior.
(17:19):
Someone who always participatedin a bath now is resisting you.
That might indicate there's pain there.
So you're looking for change.
Dana Rampolla (17:29):
Okay.
Okay.
And before we go, what's a takeawaythat you hope listeners remember
about pain and dementia care?
Barbara Resnic (17:37):
Well, I, I think the important thing is to think
about it always, that it's possiblethat it's there and to look for
it, to assess for the cause.
Why might you be resisting me today?
What's hurting?
Is your shoulder warm?
Is there something going on there to,to be a detective when it comes to
(18:02):
looking for pain and then not justignoring it and assuming it's normal,
treating the cost if you can, and thenimplementing the many non-pharmacological
interventions positioning.
Um.
Distraction movement, hot, cold,anything you can do to relieve that pain.
(18:28):
There's some of coursealternative treatments like
acupuncture that work for people.
Again, those have a cost associatedand, um, are more difficult to access,
particularly for people in nursing homes.
But to assess, treat, and manage.
Dana Rampol (18:48):
That's great advice and lots of tips I might not have
even thought of, especially when Iwas younger and it was my grandmother.
So I hope that helps one of our listenersor many of our listeners, um, figure
out just how to care for their lovedones, whether they are in an at home
situation or in a nursing home, or.
Other care facility.
Barbara, I'm curious, before we sign off,what, what prompted you to go into this
(19:12):
type of research and had you done otherresearch prior to this that led to it?
Barbara Resn (19:18):
Yeah, so my entire career has been working in, well
with older adults, but mostlyin long-term care communities.
Ever since I was 16, I startedas a nursing assistant.
Oh, wow.
Even at 16, I was taking peopleout of their, then what were
(19:40):
referred to as Houdini Vest.
Um, they were restraints and walkingpeople to optimize function, relieve
pain, and improve quality of life.
And I've spent my entire career focusedon that, um, particularly on optimizing
function and physical activity.
(20:00):
Well.
Function and physical activitydon't happen if somebody's in pain.
And so it's really the combinationof those two things that drives
me to help people with pain atthis, you know, at this time.
(20:20):
And it's also, I've done a lot of workto help communities implement, um,
different types of care approaches,so they become routine care.
Dana Rampolla (20:33):
Thank you for all that you do, and thank
you for sharing that with us.
And thank you, you know, just for talkingin a way that our listeners will be able
to absorb and understand and hopefullyput into action all of the tips and
tricks and advice that you've given.
Thank you Barbara again,and have a great day.
Barbara Resnick (20:51):
Thank you.
Charles Sc (20:55):
After the interview, Dr. Resnick shared more about how
the research works in practicethrough an NIH funded study.
Her team works directlywith nursing home staff.
A nurse interventionist doesrounds with caregivers, helps them
evaluate residents for pain anddevelops personalized care plans.
(21:16):
The team then reviews electronichealth records to see whether
pain is being properly assessed,documented and treated, helping
ensure residents receivecare tailored to their needs.
Barbara Resnick (21:27):
This is an NIH study and you have a team.
It's a theoretically basedapproach and, um, we have a nurse
interventionist that works with thestaff using a four step project.
We have a staff, we have a stakeholderteam, but, uh, the research n Nurse
(21:47):
interventionist works with the staff toevaluate, literally does rounds evaluates
um, residents for pain and works withthem to comprehensively assess it, develop
a personalized, uh, care plan, and thenimplement that care plan around pain.
(22:07):
Then what we do is we look at thepatient's electronic health record
to see if there's been improvementsin the way pain is assessed.
And, well documented to begin with, assessdocumented for the underlying cause,
and then whether appropriate treatmentsthat are personalized for that person.
(22:34):
So we, you know, it's a, it'sa comprehensive intervention
that way, but it's really forthe staff within the community.
The staff within the communityto, um, implement rather than,
you know, it's not us doing theintervention, it's working with them.
It's more of an implementation study.
(23:01):
The UMB Pulse with Charles Schelleand Dana Rampolla is a UMB Office
of Communications and PublicAffairs production edited by Charles
Schelle, marketing by Dana Rampolla.
When someone is in pain, we usually expect them to
say, so just tell me what's wrong.
But sometimes they can't do that.
And what happens when they can't?
For people living with dementia,pain doesn't always show up
the way we expect either.
Instead of saying, this hurts.
Someone might become agitated, theymight become withdrawn or even resistant
(00:20):
to care, and those behaviors caneasily be mistaken for something else.
And then when that happens,the pain can go untreated.
Our guest today is working to change that.
Dr. Barbara Resnick is a professor atthe University of Maryland School of
Nursing and an internationally recognizedexpert in aging and long-term care.
Her research supported by the NationalInstitutes of Health focuses on
(00:44):
improving quality of life for olderadults, and that includes helping
nursing home staff better recognizeand manage pain in
residents with dementia.
Her work is helping caregiverslook beyond behavior, identify
root causes of discomfort, and usesafer approaches to relieve pain.
Sometimes without relying onmedications, that can also
(01:06):
increase confusion and fall risk.
Join me as I chat with Dr. BarbaraResnick about what pain really
looks like in people with dementiaand how recognizing it differently
could dramatically improve care.
I'm Dana Rampolla andthis is the UMB Pulse.
Jena Frick (01:26):
You are listening to the heartbeat of the University of
Maryland, Baltimore, the UMB Pulse.
Dana Rampolla (01:44):
Dr. Resnick.
Thank you so much for joining ustoday on the UMB Pulse Podcast.
Barbara Resnick (01:50):
It's a pleasure to be here.
Thank you.
Dana (01:53):
We are excited to welcome you on the UMB Pulse today because you are
also featured in our Breakthroughs Can'tWait campaign, which is a communications
campaign we've been running for sometime here at the University of Maryland
Baltimore, featuring researchers andwhy research matters, why funding for
research matters, and I personally findyour topic of research so interesting.
(02:16):
Just to jump right in, you were.
Researching why, um, and how peoplereact to pain, especially when
there are people who are going,you know, experiencing dementia.
So let's talk a little bit abouthow that's why that's important and
why it's not always straightforward.
(02:36):
Oftentimes people with dementia maynot be able to communicate to us what's
going on when we're used to hearingsomebody just simply say, it hurts, or,
I have pain in my knee, can you help me?
So how does this affect.
People who aren't able to explainthings in such simple words.
Barbara R (02:54):
So first of all, it's critically important because it's so often
missed and you're absolutely correct.
Um, many times it's missed becausepeople can't communicate it.
There's also an assumption thateverybody older has pain, so no big deal.
So I just ignore it.
So there is that issue.
(03:17):
Um, but the other really concerning thing.
About pain and people living withdementia is they express it in ways
that get interpreted as other problems.
For example, if you are impaired,you can't express the pain, but
(03:38):
it hurts, what would you do?
You're going to hit somebody ifthey move a joint and then it hurts.
The reaction is to go like that.
And so it often gets interpretedas behavioral symptoms.
It gets treated maybe as a behavioralsymptom rather than looking for the
(03:59):
underlying cause of the pain and treatingthat or treating the pain appropriately.
Dana Rampolla (04:06):
Well, and you've spent a lot of time studying this.
Was there a moment in your work when yourealized just how often people who have
dementia ex their, their pain experiencesbeing missed the way you just described?
Barbara Resnick (04:18):
Yeah.
Well, it, it's hard to.
Tell that for sure because we wouldhave to do some additional testing to
really know, but I would say it's atleast 50% and it's really interesting.
If you look at studies about painand people living with dementia, the
percentage of pain runs anywhere from 9%.
(04:42):
To 88% of people being in pain.
Now, these are different samples, butstill you see that big range really
raises concerns, and I have found in myown work that pain is not recognized.
Not documented.
Not assessed, and not managed.
Dana Ram (05:05):
And you just mentioned how behaviors like being irritable
or hitting someone can be signsof pain, and that's something that
people may not think of immediately.
Why do you think those signalsget misunderstood so often?
Barbara R (05:19):
Well, because they're often considered as signs of dementia.
They're called behavioralsymptoms associated with dementia.
Sometimes other terms are used.
And so it's not unusual tosee that behavior just happen.
Uh, maybe, I mean,think about it yourself.
(05:40):
Even if you're not having pain,somebody came and started taking your
clothes off, you might resist them.
You might hit them.
It could be pain 'cause it hurts whenyou got moved, but it also could just be,
uh, confused with a behavioral symptom.
So it is hard to differentiate versuswhen somebody just out and out says,
(06:02):
I have pain in my arm or my shoulder.
When you move it
Dana Rampolla (06:07):
right,
Barbara Resnick (06:07):
stop.
We're so lucky, right?
We're not so lucky when working withpeople who are living with dementia.
Dana R (06:15):
And when that pain isn't recognized in a person with dementia,
what can that mean for their day-to-dayhealth and their quality of life?
Barbara Resn (06:23):
Well, it certainly decreases anybody's quality of life
when you're hurt, but it also becomes avicious cycle where somebody's in pain,
they move less, there's less function, acurrent, a continual decline in function.
More pain.
(06:43):
And the other thing we can see ismore behavioral symptoms, which is
really a concern because then yougo down this other path of people
trying to treat behavioral symptoms,which may be with drugs that are
sedating and uh, other problems.
Dana Rampolla (07:00):
And
Barbara Resnick (07:00):
then it
Dana Ramp (07:01):
cause other problems.
Barbara Resnick (07:02):
Right?
Exactly.
Exactly.
Dana Rampolla (07:05):
Hmm.
I think back when I was in college,my grandmother lived with us
for a, a long period of time.
She had Alzheimer's and then shewound up, you know, for the end of
her life, being in a nursing home.
And it makes me a little nervous becauseI wonder if we understood some of the
signs that maybe she was exhibiting thatshe could have been in pain when we just
(07:26):
took it for the way you just described.
So what, what are signs thatyou would tell people to look
for if they have a loved one?
Barbara Resnick (07:34):
So some things that we commonly see.
First of all, it's facial expressionsand everybody's really a little
different, but when you have pain,your face does something usually.
So facial expressions and notignoring them are really important.
Um, iveness to care is avery common response to pain.
(07:59):
What would anyone do?
It hurts.
I'm gonna lash out at you,or I'm gonna pull back.
Oh.
Um, some things might be, uh, hitting,kicking, biting, screaming, those types
of things, particularly when they'reassociated with maybe a movement
versus the person just lying there.
(08:22):
Some people withdraw into themselveswhen they have pain to cope, so it
might be just curled up in a ball.
If you touch the person, you'llsee some of those other, they
might again hit lash out.
You can see a decrease inappetite, decrease willingness
to engage in any activities.
(08:44):
All of those could besigns and symptoms of pain.
Dana Rampolla (08:49):
Wow.
There are lots of different thingsto look for and it's hard when
someone can't really explain.
And one thing that stood out to me inyour research is that sometimes the
cause of the pain could be somethingvery simple, like their nails being too
long is an irritant to them, or maybethey have a small physical discomfort
that isn't necessarily a pain reaction.
(09:10):
So why is identifying the root causesuch an important part of the process?
Barbara Res (09:15):
Well, first of all, this is probably one of the biggest
mixed missed activities around pain.
It is not assessed comprehensively anddiagnosed and the underlying treatment.
Doesn't happen.
If you treat the underlying problem,you're gonna help the pain without
giving the person drugs or, I mean,non-pharmacological interventions are
(09:41):
terrific, but they also take time.
It might not be necessary if youcut the nails that are hurting.
Um, if you identify, sometimesit's a pressure sore.
The person might be able to even pointto the area, but nobody noted it.
Nobody found it.
Sometimes it may be a reallyimportant acute problem.
(10:03):
Um, so looking for that causeis critical, but it requires a
comprehensive, really, history issometimes hard to get in these people,
but you could do a comprehensive exam.
And identify the pain.
The majority of the painis often positioning.
(10:25):
If you lay with your head like thisor like this and just repositioning,
people can make a difference.
So it's critical to lookfor that cause at least.
Dana Ramp (10:39):
That's a great point.
And you're helping nursing homesput updated national pain management
guidelines into place, correct?
Barbara Resnick (10:46):
Correct.
Dana Ra (10:48):
And in in simple terms, what are those guidelines encouraging
caregivers to maybe do differently?
You said to give a comprehensive report,but what specifically would that mean?
Barbara Resnic (10:57):
So it, it really takes the approach of assessing people
for pain, looking for the underlyingproblem, treating the underlying
problem, and treating the pain firstwith non-pharmacological interventions.
And then if those do not alleviatethe pain, then adding pharmacological
(11:19):
appropriate pharmacological interventions.
And so we use a lot of.
Innovative non-pharmacological approaches,particularly in people wi living with
dementia because the pharmacologic agentscan cause significant side effects.
Dana Ramp (11:37):
So is that an example that you just gave where maybe you
would try to turn someone over orsit them up, something like that?
Or are there other types of things?
Barbara Resnick (11:46):
Absolutely.
Positioning and physical activity.
Are probably our most common and mosteffective non-pharmacological approaches.
And think about it yourself.
If you have flu and you lay in bed for aday, you ache like heck when you get up?
How do you think it feels dayafter day for these people lying
(12:08):
in bed Positioning is critical.
So we do do a lot of that to helprelieve really vague kind of chronic
pain, but it can be bothersome.
Um, and then there's many othernon-pharmacological approaches.
We use everything from heat, ice, um,distraction is a really big one as well.
(12:34):
And other, other techniques.
Dana Rampo (12:38):
Barbara, I feel that way sitting in my chair all day.
Exactly.
I think I need to changeposition or get an ice pack.
Barbara Resnick (12:46):
Get up.
No.
Get up and take a walk.
Dana Rampolla (12:48):
Right, right.
Barbara (12:49):
Get up and take a walk.
Dana Ra (12:51):
if we can get people to widely adopt these, these guidelines
and these um, actions, do you thinkthat it will change the care experience
for someone living with dementia?
Barbara R (13:02):
I think it can make a major difference and as we, um, implement
the guidelines, we're not asking staffto do anything that they shouldn't be
doing already or anything that can't,uh, be incorporated into routine care.
So it's not hard to do these.
(13:23):
And these are all really things thatare required in nursing home care.
Based on, um, state andfederal requirements.
Dana Rampo (13:35):
Another thing that I remember reading you mentioning, just
going back to the non-invasive type,um, care you had talked about, like
having conversations with, with peoplemaybe bringing up happy memories.
If they ha if they have the abilityto recall, say from the past,
do you think that can actuallybe a simple way to help someone?
(13:58):
You know, kind of focus on somethingdifferent, like kind of like moving their
body, moving their brain a little bit too.
Barbara Resnick (14:04):
Well, it's distraction is great.
And what do we all do when we have pain?
You try and distract yourself.
You'll read a book, you listento a book you watch, tell
you do something to distract.
So those conversations.
Can be distracting.
They take your mind off the pain.
(14:26):
The other thing that's veryinteresting from a physiological
perspective is even just being kind,which is part of that conversation.
It's a more positive care interaction andbeing kind causes a change in our brains
(14:47):
and the neuro neurological circuitry.
So that it actually decreases pain.
So that's another but more, it gets intosome of the physiological reasons why
this works, but it works and it doesn'ttake a staff member any more time to be
(15:08):
kind when you're working with somebody.
Just talking with them and distractingthem can help you get through that bath.
Without causing pain versus justapproaching somebody and moving joints.
That hurt.
Dana (15:24):
Yeah, I completely agree.
Um, just letting them feel like theymatter and that you care about what
they're saying, even if they're tellingyou that story for the 10th time.
Barbara Resnick (15:35):
Mm-hmm.
Dana Ramp (15:36):
For someone listening who has a parent or maybe a grandparent
in long-term care, is there a questionthat they should be asking caregivers
when it comes to pain management?
Barbara Resnick (15:46):
I, I think it's asking a, number one, have they
seen any indication of pain?
It just raises the issue, you know?
Have you seen, my momtends to, uh, do this.
If she has pain, she'll bring upher legs and curl up into a ball.
They, they can ask about that.
(16:06):
Um, and then I think it's alwaysimportant to ask about, have
you been getting mom outta bed?
Um, moving, depending on what,hi mom or dad's or whoever's
underlying capability is, if theycan walk, have they been walking?
You know, just finding out.
If they've been doing those things or ifthere's any change in behavior because
(16:31):
change in behavior might indicate pain.
Also, things like, you know,are they eating as they used to?
Are they going to activities,those types of things.
Dana Rampoll (16:43):
And what about for the person who may be a caregiver
still in the home for a loved one?
Can they do anything that wouldmake a big difference in the
comfort or the same types of things?
Barbara Resnick (16:52):
I, I would say it's the same types of things.
Of course, they have theopportunity of knowing that person.
Even better.
And so they should, because they're onlytaking care of one person, hopefully.
Um, and even you see the samething in small assisted livings
because you, you really get toknow that small group of patients.
So you're looking for changes, facialexpressions, but changes in behavior.
(17:19):
Someone who always participatedin a bath now is resisting you.
That might indicate there's pain there.
So you're looking for change.
Dana Rampolla (17:29):
Okay.
Okay.
And before we go, what's a takeawaythat you hope listeners remember
about pain and dementia care?
Barbara Resnic (17:37):
Well, I, I think the important thing is to think
about it always, that it's possiblethat it's there and to look for
it, to assess for the cause.
Why might you be resisting me today?
What's hurting?
Is your shoulder warm?
Is there something going on there to,to be a detective when it comes to
(18:02):
looking for pain and then not justignoring it and assuming it's normal,
treating the cost if you can, and thenimplementing the many non-pharmacological
interventions positioning.
Um.
Distraction movement, hot, cold,anything you can do to relieve that pain.
(18:28):
There's some of coursealternative treatments like
acupuncture that work for people.
Again, those have a cost associatedand, um, are more difficult to access,
particularly for people in nursing homes.
But to assess, treat, and manage.
Dana Rampol (18:48):
That's great advice and lots of tips I might not have
even thought of, especially when Iwas younger and it was my grandmother.
So I hope that helps one of our listenersor many of our listeners, um, figure
out just how to care for their lovedones, whether they are in an at home
situation or in a nursing home, or.
Other care facility.
Barbara, I'm curious, before we sign off,what, what prompted you to go into this
(19:12):
type of research and had you done otherresearch prior to this that led to it?
Barbara Resn (19:18):
Yeah, so my entire career has been working in, well
with older adults, but mostlyin long-term care communities.
Ever since I was 16, I startedas a nursing assistant.
Oh, wow.
Even at 16, I was taking peopleout of their, then what were
(19:40):
referred to as Houdini Vest.
Um, they were restraints and walkingpeople to optimize function, relieve
pain, and improve quality of life.
And I've spent my entire career focusedon that, um, particularly on optimizing
function and physical activity.
(20:00):
Well.
Function and physical activitydon't happen if somebody's in pain.
And so it's really the combinationof those two things that drives
me to help people with pain atthis, you know, at this time.
(20:20):
And it's also, I've done a lot of workto help communities implement, um,
different types of care approaches,so they become routine care.
Dana Rampolla (20:33):
Thank you for all that you do, and thank
you for sharing that with us.
And thank you, you know, just for talkingin a way that our listeners will be able
to absorb and understand and hopefullyput into action all of the tips and
tricks and advice that you've given.
Thank you Barbara again,and have a great day.
Barbara Resnick (20:51):
Thank you.
Charles Sc (20:55):
After the interview, Dr. Resnick shared more about how
the research works in practicethrough an NIH funded study.
Her team works directlywith nursing home staff.
A nurse interventionist doesrounds with caregivers, helps them
evaluate residents for pain anddevelops personalized care plans.
(21:16):
The team then reviews electronichealth records to see whether
pain is being properly assessed,documented and treated, helping
ensure residents receivecare tailored to their needs.
Barbara Resnick (21:27):
This is an NIH study and you have a team.
It's a theoretically basedapproach and, um, we have a nurse
interventionist that works with thestaff using a four step project.
We have a staff, we have a stakeholderteam, but, uh, the research n Nurse
(21:47):
interventionist works with the staff toevaluate, literally does rounds evaluates
um, residents for pain and works withthem to comprehensively assess it, develop
a personalized, uh, care plan, and thenimplement that care plan around pain.
(22:07):
Then what we do is we look at thepatient's electronic health record
to see if there's been improvementsin the way pain is assessed.
And, well documented to begin with, assessdocumented for the underlying cause,
and then whether appropriate treatmentsthat are personalized for that person.
(22:34):
So we, you know, it's a, it'sa comprehensive intervention
that way, but it's really forthe staff within the community.
The staff within the communityto, um, implement rather than,
you know, it's not us doing theintervention, it's working with them.
It's more of an implementation study.
(23:01):
The UMB Pulse with Charles Schelleand Dana Rampolla is a UMB Office
of Communications and PublicAffairs production edited by Charles
Schelle, marketing by Dana Rampolla.
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