Cognitive impairment and pain management: Review of issues and challenges

Abstract

Abstract-The assessment and treatment of pain in persons with cognitive impairments pose unique challenges. Disorders affecting cognition include neurodegenerative, vascular, toxic, anoxic, and infectious processes. Persons with memory, language, and speech deficits and consciousness alterations are often unable to communicate clearly about their pain and discomfort. Past research has documented that persons with cognitive impairments, particularly dementia, are less likely to ask for and receive analgesics. This article provides an overview of the assessment, treatment, and management of pain in adults with cognitive impairments. We review types of cognitive impairment; recent work specific to best practices for pain management in patients with dementia, including assessmenttool development and pharmacological treatment; challenges in patients with delirium and in medical intensive care and palliative care settings; and directions for future research.

Pain and palliative medicine

“…Therefore, a focus on the regular monitoring of pain alone is limited. Future improvements in clinical care should address the measurement of multiple symptoms using very simple tools [20], an understanding of which dimensions of pain are most important in palliative care, pain assessment in the cognitively impaired patient [21], and a delineation of the sources of pain in noncancer palliative care patients.…”

Får bedre smertebehandling

“…Pasienter med lettere grad av demens er i stand til å bruke selvrapporteringsskjema, og dette bør man prøve ut (2,11,16). Det finnes enkle smerteregistreringsskalaer for selvrapportering av smerteintensitet deriblant numerisk rangeringsskala (NRS), verbal skala (VRS), visuell analog skala (VAS) og ansiktsskala.…”

“…Observasjonsbaserte kartleggingsverktøy er anbefalt til bruk hos personer med alvorlig demens (2,8,(10)(11)(12). Vi har funnet tre kartleggingsverktøy oversatt til norsk og utprøvd i norske sykehjem.…”

“…Men kartleggingsverktøy gir ikke en enkel løsning på et mulig smerteproblem. Det er viktig at pasienten utredes videre hvis et smerteproblem avdekkes (8,11). ||||…”

“…Undersøkelser viser at demente ofte er underbehandlet for smerte (1,2,(7)(8)(9)(10)(11)(12)(13). Årsaker til dette kan vaere utilstrekkelig smertekartlegging eller manglende bevissthet på at demente kan ha vondt (12).…”