[Pain management in people with dementia : Recognizing pain and providing supportive care]

Pain in dementia is frequently underrecognized, although early and reliable detection is fundamental to any effective pain management. Structured assessment combines subjective scales (for Mini-Mental State Examination [MMSE] ≥ 10) with observer-based scales (for MMSE < 10), evaluated both at rest and during movement. Responsive behaviors may indicate pain, making differentiated observation essential. Multimodal therapy includes both non-pharmacological and pharmacological interventions. Criteria lists for potentially inappropriate medications support risk-adapted prescribing. Opioids are not standard therapy for chronic non-cancer pain and should only be used when clearly indicated, after exhausting other treatment options, and under regular reassessment of benefits and risks. The principle of "start low, go slow" is central to analgesic therapy in patients with dementia.