TY - JOUR T1 - Assessing pain in dementia: tools or tacit knowledge (or both)? JF - British Journal of General Practice JO - Br J Gen Pract SP - 196 LP - 197 DO - 10.3399/bjgp18X695657 VL - 68 IS - 669 AU - Cathy Wernham AU - Alice Jordan AU - Julian C Hughes Y1 - 2018/04/01 UR - http://bjgp.org/content/68/669/196.abstract N2 - In the UK approximately 770 000 people are affected by dementia, with the prevalence predicted to rise to 1.2 million by 2040 as the population ages.1 It is clearly important that GPs are confident in their treatment of people living with dementia.Estimates of the prevalence of pain vary, but probably about 50% of people with dementia experience pain regularly.2 This is understandable given that older patients are likely to have a variety of painful chronic comorbidities and when communication is compromised it becomes difficult to identify pain in people with dementia. Seminal studies suggested that pain in people with severe dementia has been under-recognised and under-treated.3 In 2007, the National Institute for Health and Clinical Excellence (NICE)–Social Care Institute for Excellence (SCIE) guidelines on dementia suggested: ‘If a person with dementia has unexplained changes in behaviour and/or shows signs of distress, health and social care professionals should assess whether the person is in pain, using an observational pain assessment tool if helpful. However, the possibility of other causes should be considered.’ 4In recent years, there has been a proliferation of observational pain tools. A systematic review found 28 such tools, which had been studied in a variety of settings, and confirmed that ‘no one tool can be recommended given the existing evidence’.5 The NICE–SCIE guidelines seem exactly right and go on to commend holistic assessment. They acknowledge the concern ‘that pain assessment tools might detect distress caused by other factors’.4Our concern is that, despite the guidelines, (a) some practitioners might not see how assessment tools can be helpful and, … ER -