A recent study of more than 2.1 million point-of-care pain assessments conducted on 89,230 nursing home residents over five years using PainChek, an AI-powered pain assessment tool, found a strong connection between pain and behaviors often associated with dementia.
The study also found that caregiver burden increased significantly as pain levels rose. Residents with severe pain had caregiver burden scores nearly seven times higher than those with little or no pain. This finding is particularly important for an industry already challenged by workforce shortages, burnout, absenteeism, workers' compensation claims, and staff retention issues.
The Behaviors That Flag Pain and the One That Doesn't
Researchers analyzed eleven behavioral indicators captured during PainChek assessments and measured how strongly each was associated with moderate-to-severe pain. Ten of the eleven showed a strong, statistically significant relationship.
Strongest indicators of unrecognized pain:
- Distress: 12x higher odds of moderate-to-severe pain
- Altered sleep: 6x higher odds
- Crying: 4.4x higher odds
- Restlessness: 4.2x higher odds
- Resisting care: 3.7x higher odds
The outlier was pacing and wandering, which showed no significant link to pain intensity. This suggests wandering may be driven by factors other than pain, while distress and sleep disturbances warrant closer evaluation before being attributed solely to dementia.
Why This Matters
Researchers developed a caregiver burden score based on these behaviors and compared it across pain levels:
| Pain Level | Average Caregiver Burden Score |
| No Pain | 0.6 |
| Mild Pain | 2.5 |
| Moderate Pain | 3.9 |
| Severe Pain | 5.3 |
The results showed a clear relationship between increasing pain and increasing caregiver burden. Unrecognized or undertreated pain affects not only residents' quality of life but also the daily workload and stress experienced by care teams.
What This Means for Care Teams
While the researchers note several limitations, the findings highlight an important clinical consideration: behaviors such as distress, altered sleep, crying, and resistance to care may be expressions of pain rather than solely behavioral or psychiatric symptoms.
For residents who cannot reliably self-report pain, particularly those with moderate-to-severe dementia, standardized pain assessment provides an objective way to identify and address pain that might otherwise go unnoticed.
The Takeaway
Many behaviors commonly documented as agitation or "sundowning" may be a resident's way of communicating pain. By giving care teams a consistent, objective method to identify pain, organizations can improve resident outcomes while reducing caregiver burden and workplace stress.
Read the research article here: Frontiers | Pain in people with dementia is a significant contributor to increased professional caregiver burden; results of an observation study
Source: Hoti K, Vahia I, Chivers P, Hughes J. Pain in people with dementia is a significant contributor to increased professional caregiver burden: results of an observation study. Front. Pain Res. 7:1868192 (2026). Open access, CC BY 4.0.
Want to see how standardized pain assessment could work for your community? Contact the PainChek team: [email protected] | 1800 720 7504
