Are Chronic Pain Patients with Dementia Being Undermedicated?

Achterberg, Wilco P.; Erdal, Ane; Husebø, Bettina S.; Kunz, Miriam; Lautenbacher, Stefan

doi:10.2147/jpr.s239321

Cited by 42 publications

(38 citation statements)

References 62 publications

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“…Oversedation or withdrawal from pain medication can exhibit symptoms which can be misinterpreted (e.g., as psychiatric symptoms, with possibly more medication being prescribed), and people in residential care are more susceptible to side effects from polypharmacy, especially delirium [ 91 ]. Professionals described a ‘sundown syndrome’ for residents with dementia in which pain becomes worse in the evening and nighttime, causing increased aggression, restlessness and sleep disturbances and cognitive impairment [ 73 ], potentially resulting in undermedication [ 92 , 93 ]. This can lead to hypnotic prescribing, whereby hypnotics are prescribed alongside strong opiates.…”

Section: Resultsmentioning

confidence: 99%

Understanding the Needs and Priorities of People Living with Persistent Pain and Long-Term Musculoskeletal Conditions during the COVID-19 Pandemic—A Public Involvement Project

et al. 2022

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Background: Critiques of public involvement (PI) are associated with failing to be inclusive of under-represented groups, and this leads to research that fails to include a diversity of perspectives. Aim: The aim of this PI project was to understand the experiences and priorities of people from three seldom-heard groups whose musculoskeletal pain may have been exacerbated or treatment delayed due to COVID-19. Engaging representatives to report diverse experiences was important, given the goal of developing further research into personalised and integrated care and addressing population health concerns about access and self-management for people with musculoskeletal pain. Methods: The project was approved via Sheffield Hallam University Ethics but was exempt from further HRA approval. A literature review was conducted, followed by informal individual and group discussions involving professionals and people with lived experience of (a) fibromyalgia pain, (b) those waiting for elective surgery and (c) experts associated with the care home sector. Findings from the literature review were combined with the insights from the public involvement. Resulting narratives were developed to highlight the challenges associated with persistent pain and informed the creation of consensus statements on the priorities for service improvement and future research. The consensus statements were shared and refined with input from an expert steering group. Results: The narratives describe pain as a uniformly difficult experience to share with professionals; it is described as exhausting, frustrating and socially limiting. Pain leads to exclusion from routine daily activities and often resigns people to feeling and being unwell. In all cases, there are concerns about accessing and improving services and critical issues associated with optimising physical activity, functional wellbeing and managing polypharmacy. Exercise and/or mobilisation are important and commonly used self-management strategies, but opportunity and advice about safe methods are variable. Services should focus on personalised care, including self-management support and medication management, so that people’s views and needs are heard and validated by health professionals. Conclusions: More research is needed to explore the most effective pain management strategies, and public involvement is important to shape the most relevant research questions. Health and care systems evaluation is also needed to address the scale of the population health need. The pandemic appears to have highlighted pre-existing shortcomings in holistic pain management.

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Section: Resultsmentioning

confidence: 99%

Understanding the Needs and Priorities of People Living with Persistent Pain and Long-Term Musculoskeletal Conditions during the COVID-19 Pandemic—A Public Involvement Project

et al. 2022

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“…It may be that the reduced ability to perform both fulfilling and routine everyday activities is the mechanism by which pain reduces dignity in these domains. Family and professional caregivers should be informed that pain is often under-recognized and undertreated in PwD and they should be taught how to recognize its symptoms [ 55 ]. Alleviating pain can have impact on overall wellbeing of PwD including their improved perception of dignity.…”

Section: Discussionmentioning

confidence: 99%

Perception of dignity in older men and women in the early stages of dementia: a cross-sectional study

et al. 2022

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Background Dementia is a serious problem in old age, that impacts an individual’s ability to function and may threaten personal dignity. Given the variable features of the illness and the diversity of life experiences, many factors may contribute to the perception of dignity by men and women with dementia. The purpose of the study was to explore the factors that contribute to dignity and its domains in men and women with dementia. Methods This cross-sectional study involved 316 community-dwelling patients with early-stage dementia (aged ≥ 60) (PwD). We assessed the participants’ sociodemographic and social involvement characteristics, health-related variables (pain, depression, physical performance, visual and hearing impairments), attitude to aging, and self-sufficiency in the activities of daily living (ADL). These factors were investigated as independent variables for the perception of dignity and of its domains in men and women. Results Multivariate regression analysis showed that PwD experienced minor dignity problems in the early stages of dementia. In both men and women higher rates of depression, negative attitudes to aging, and pain were associated with reductions in the perception of dignity. In men, but not in women visual impairment had a negative effect on overall dignity, and on the associated domains of ‘Loss of Autonomy’ and ‘Loss of Confidence’. In women, lowered self-sufficiency in ADL contributed to reduced self-perception of dignity and in the associated domains of ‘Loss of Purpose of Life’, ‘Loss of Autonomy’, and ‘Loss of Confidence’. Sociodemographic and social involvement characteristics, hearing impairment, and physical performance did not influence the participants’ self-perception of dignity. Conclusion The results suggested that several common factors (depression, attitudes to aging, and pain) contribute to the perception of dignity in both men and women. Other factors, visual impairments in men, and self-sufficiency in ADL in women, appear to be more gender specific. These differences might relate to their specific gender roles and experiences. The self-perception of dignity in PwD can be helped by supporting the individual, to the extent that their illness allows, in maintaining activities that are important to their gender roles, and that preserve their gender identity. Trial registration NCT04443621.

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“…Oversedation or withdrawal from pain medication can exhibit symptoms which can be misinterpreted (e.g. as psychiatric symptoms, with possibly more medication being prescribed) and people in residential care are more susceptible to side-effects from polypharmacy, especially delirium [91].Professionals described a "sundown syndrome" for residents with dementia in which pain becomes worse in the evening and night-time causing increased aggression, restlessness and sleep disturbances and cognitive impairment [92]potentially resulting in undermedication [93,94]. This can lead to hypnotic prescribing whereby hypnotics are prescribed alongside strong opiates.…”

Section: Complexity Of Pain Medication For Older Residentsmentioning

confidence: 99%

Understanding the needs and priorities of people living with persistent pain and long-term musculoskeletal conditions during the Covid-19 pandemic.

Fowler-Davis

Humphreys

Maden‐Wilkinson

et al. 2022

Preprint

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Background: Critiques of public involvement (PI) are associated with failing to be inclusive of under-represented groups and this leads to research that fails to include a diversity of perspectives. Aim: The aim of this PI project was to understand the experiences and priorities of people from three seldom heard groups whose musculoskeletal pain may have been exacerbated or treatment delayed due to COVID-19. Engaging representatives to report diverse experiences was important, given the goal of developing further research into personalised and integrated care and addressing population health concerns about access and self-management for people with musculoskeletal pain.Methods: The project was approved via Sheffield Hallam University Ethics but was exempt from further HRA approval. A literature review was conducted followed by informal individual and group discussions involving professionals and people with lived experience of fibromyalgia pain, those waiting for elective surgery and experts associated with the care home sector. Findings from the literature review were combined with the insights from the public involvement. Together, these formed narratives that highlighted the challenges associated with persistent pain and informed the creation of consensus statements on the priorities for service improvement and future research. The consensus statements were shared and refined with input from an expert steering group.Results: The narratives describe pain as a uniformly difficult experience to share with professionals; it is described as exhausting, frustrating, and socially limiting. Pain leads to exclusion from routine daily activities and often resigns people to feeling and being unwell. In all cases there are concerns about accessing and improving services and critical issues associated with optimising physical activity, functional wellbeing and managing polypharmacy. Exercise and/or mobilisation are important and commonly used self-management strategies but opportunity and advice about safe methods are variable. Services should focus on personalised care including self-management support and medication management so that people’s views and needs are heard and validated by health professionals. Conclusions: More research is needed to prioritise the most effective pain management strategies and public involvement is important to shape the most relevant research questions. Health and care systems evaluation is needed to address the scale of the population health need. The pandemic appears to have highlighted pre-existing shortcomings in holistic pain management.

show abstract

Are Chronic Pain Patients with Dementia Being Undermedicated?

Cited by 42 publications

References 62 publications

Understanding the Needs and Priorities of People Living with Persistent Pain and Long-Term Musculoskeletal Conditions during the COVID-19 Pandemic—A Public Involvement Project

Understanding the Needs and Priorities of People Living with Persistent Pain and Long-Term Musculoskeletal Conditions during the COVID-19 Pandemic—A Public Involvement Project

Perception of dignity in older men and women in the early stages of dementia: a cross-sectional study

Understanding the needs and priorities of people living with persistent pain and long-term musculoskeletal conditions during the Covid-19 pandemic.

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