Common Pain Behaviors Seen in Cognitively Impaired Residents

Pain is often undiagnosed in patients with cognitive impairment. Poorly managed pain in residents with dementia can lead to behaviors that may be misinterpreted and result in unnecessary psychoactive medication utilization. Here are common behaviors seen in cognitively impaired residents in pain.

Facial Expressions

Facial expressions are one behavior seen in cognitively impaired residents in pain. Frowning, grimacing, wrinkled forehead, closed or tightened eyes, rapid blinking, or any distorted expression are all facial expressions that may indicate pain.


Vocalizations are another behavior often seen in cognitively impaired residents in pain. Sighing, moaning, groaning, grunting, chanting, calling out, noisy breathing, cries for help,  or verbal abuse can be an indication of pain.

Body Movements

Body movements including rigid or tense body posture, guarding, fidgeting, increased pacing, rocking, restricted movement, gait or mobility changes can all be an indication of untreated pain in residents with cognitive impairment.

Changes in Interpersonal Interactions

Residents with cognitive impairment may show signs of aggression, or combativeness. At times, the resident may even resist care. Decreased social interactions, socially inappropriate behavior, or social withdrawal.  All of these behavioral changes should prompt clinicians to assess a cognitively impaired resident for pain before initiating psychoactive therapy.

Changes in Activity Patterns or Routines

When undiagnosed pain is present in cognitively impaired residents, caregivers may notice changes in activity patterns or routines.  Changes in appetite or rest patterns, even increased wandering are behaviors that can be associated with untreated pain.

Mental Status Changes

Lastly, crying, increased confusion, irritability or distress are all behavioral signs that can indicate undiagnosed pain in cognitively impaired residents.   

Assessing pain in cognitively impaired residents may present certain challenges.  Clinicians should monitor residents for these common behaviors and utilize a validated pain assessment tool to assure pain is addressed in cognitively impaired residents.



HHS Understanding Pain Communication Handout 04-01-14

Texas OASIS HCBS Dementia Training Academy Participant Manual