What I can do

If you suspect someone is in pain, ask them:

• Where is the pain and when did it start?
• How does it feel — stabbing, dull, crushing, or burning?
• How intense is the pain?

You can also carefully assess pain by:

• Using pain assessment tools such as the Symptom Assessment Scale, Pain Thermometer (105kb pdf), or Modified Resident’s Verbal Brief Pain Inventory (M-RVBPI) (112kb pdf)
• Observing non-verbal signs such as facial expressions (frowning, grimacing), vocalisations (moaning, sighing), and restlessness.
• Applying specific tools for people with advanced dementia or those unable to communicate, such as PainChek, Pain Assessment in Advanced Dementia (PAINAD) (43kb pdf), and the Abbey Pain Scale (225kb pdf).

Escalate your concerns to a nurse, manager, or the person’s GP if:

• The person has had all prescribed pain medication but is still in pain
• The medication is not working as well as before
• The pain has changed or worsened.

Tips for Careworkers: Pain Management

 

Tips for Nurses: Pain Management

What I can learn

The palliAGED Practice Tips give helpful guidance on managing older people’s pain at the end of life. There is a version for nurses as well as one for careworkers.

You can also complete an eLearning module to increase your knowledge. Start with:

• The introductory Pain management module from palliAGED (5 mins)
• Managing pain in palliative care from PalliBytes (Free: Registration required. 15 mins each)
• The short Pain management video (2 min) from palliAGED’s Education on the Run series.

Pain management

Explore the current research evidence on this topic by reading the CareSearch Dyspnoea Clinical Evidence Summary.

Prescribers can find advice on managing breathlessness with medications in the CareSearchgp and palliMEDs apps.

CareSearchgp app

What I can give

If an older person, their family or carer want to learn more about pain and its management, these resources may help:

• Help with pain tip sheet from caring@home
• About morphine factsheet by PalAssist
• The booklet Managing pain (579kb pdf) from Marie Curie (UK)

What I can suggest

Strengthen pain management protocols by:

• Training all staff in pain assessment tools such as PAINAD or PainChek
• Ensuring routine pain assessment for all older people, especially those with dementia or communication difficulties
• Establishing clear opioid prescribing and monitoring guidelines, including opioid rotation when needed.

Improve staff education and confidence by:

• Running workshops on common morphine myths and how to discuss pain relief with families
• Providing ongoing training on opioid side effects and how to manage them
• Encouraging reflective practice through case discussions on complex pain management scenarios.

Support carers in home-based care by:

• Providing written pain management resources
• Offering carer training on administering medication and recognising pain-related distress
• Setting up regular communication channels with carers about pain management plans.

Page updated 26 February 2025