● 1ST LINE - Non pharmacologic options:

○ Positioning/Re-positioning

○ Massage therapy

○ Heat pack for stiffness / Cold pack for inflammation

○ Physical Therapy

○ Music Therapy - playing music can temporarily distract and release natural endorphins that reduce pain. 1

● 2ND LINE - Pharmacologic options (ALL HAVE SOME RISK):

○ "Tylenol - caution if history of alcoholism or liver impairment

■ Round the clock dosing for persistent pain - Max dose = 500 mg to 1,000 mg every 6 hours (not to exceed 4,000 mg per day)"

○ Certain antidepressants (cymbalta, remeron, effexor) - may help pain and mood

○ Topical analgesia - lidocaine patches, menthol cream, etc (avoid use on wounds/broken skin)

○ NSAIDs, Opioids, and muscle relaxers should generally be avoided, especially long-term use.

● General Tip: start at the lowest effective dose and use it for the shortest duration.

References:

1. Dementia-related pain management - Mayo Clinic Health System

2. Medications & Dementia | Memory and Aging Center

Version: GJ 1/5/2025