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Some people are born without the ability to feel pain--here's the wikipedia link:

wikipedia.org/wiki/Congenital_insensitivity_to_pain

Some medical papers say people with dementia become more aggressive when they are in pain, or they may become even more sensitive or lose the words to describe pain.
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My mom has dementia. She would not verbally express pain.  She would become aggressive when being cared for and often grimaced. Once she got on routine pain meds, she became cooperative and is walking better and sleeping more. The other thing she did when she was in pain was stop and put her hand on her hip when we walked. So I believe she was having hip or back pain.
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Same with my dad! He used to complain of neck pain all the time
And took tramadol every six hours. He even wanted it by his bed so he could take it in the middle of the night. Now he never mentions having pain anywhere.
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Seems like that's the case with my mom. She was basically addicted to narcotics for 50 years and when she turned about 80, her Dr wouldn't give her anything opioid related for pain. Weirdly enough, as she's progressing through dementia, she really doesn't complain of pain.
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