Chronic pain is very real for many older adults, dementia or no dementia. The problem for those with severe dementia is that they can't always articulate the location or intensity of the pain.
What caregivers should know about pain management in severe dementia:
Keep watch for pain. Reading expressions and body language is one of the best ways to monitor pain. Take note of what's happening at the time you see a physical reaction to pain, like a grimace or moan (getting in or out of bed? after eating? while sleeping?). Report what you see to your loved one's doctor.
Know that yes, strong pain medicines are available to help -- and no, you needn't worry about addiction. Someone with severe dementia isn't likely to get hooked on pain meds. To the contrary, receiving them can ease many behavioral symptoms (like poor sleep or aggression) that are exacerbated by pain.