Pain and dementia: an overview of the literature

McAuliffe, Linda; Brown, Donna; Fetherstonhaugh, Deirdre

doi:10.1111/j.1748-3743.2012.00331.x

Cited by 55 publications

(45 citation statements)

References 60 publications

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“…In addition to their loss of communication, people are often no longer able to use introspection to gain knowledge about pain, are unable to report or anticipate its onset and duration, and are unable to understand questions related to the evaluation of their pain 37. In these individuals, self-report is not an option, and a proxy rater, usually a primary caregiver, who knows the patient and their usual behavior, should be included in pain assessment.…”

Section: Assessment Perspective: the Challenges Of Pain Assessment Inmentioning

confidence: 99%

Pain management in patients with dementia

Achterberg¹,

Pieper²,

Dalen-Kok³

et al. 2013

CIA

301

253

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There are an estimated 35 million people with dementia across the world, of whom 50% experience regular pain. Despite this, current assessment and treatment of pain in this patient group are inadequate. In addition to the discomfort and distress caused by pain, it is frequently the underlying cause of behavioral symptoms, which can lead to inappropriate treatment with antipsychotic medications. Pain also contributes to further complications in treatment and care. This review explores four key perspectives of pain management in dementia and makes recommendations for practice and research. The first perspective discussed is the considerable uncertainty within the literature on the impact of dementia neuropathology on pain perception and processing in Alzheimer’s disease and other dementias, where white matter lesions and brain atrophy appear to influence the neurobiology of pain. The second perspective considers the assessment of pain in dementia. This is challenging, particularly because of the limited capacity of self-report by these individuals, which means that assessment relies in large part on observational methods. A number of tools are available but the psychometric quality and clinical utility of these are uncertain. The evidence for efficient treatment (the third perspective) with analgesics is also limited, with few statistically well-powered trials. The most promising evidence supports the use of stepped treatment approaches, and indicates the benefit of pain and behavioral interventions on both these important symptoms. The fourth perspective debates further difficulties in pain management due to the lack of sufficient training and education for health care professionals at all levels, where evidence-based guidance is urgently needed. To address the current inadequate management of pain in dementia, a comprehensive approach is needed. This would include an accurate, validated assessment tool that is sensitive to different types of pain and therapeutic effects, supported by better training and support for care staff across all settings.

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Section: Assessment Perspective: the Challenges Of Pain Assessment Inmentioning

confidence: 99%

Pain management in patients with dementia

Achterberg¹,

Pieper²,

Dalen-Kok³

et al. 2013

CIA

301

253

View full text Add to dashboard Cite

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“…In addition, patients may resist pain treatments due to their inability to understand the purpose of analgesia and may receive decreased benefit from analgesia due to the disruption of the placebo effect. 9,10 Pharmaceutical pain treatments may also exacerbate symptoms of dementia such as agitation and confusion. 11 The problems with pain management for patients with dementia lie not only in assessment and effect but also in the delivery of pain treatment.…”

Section: Introductionmentioning

confidence: 99%

Pain in Hospice Patients With Dementia

Tarter

Demiris

Pike

et al. 2016

Am J Alzheimers Dis Other Demen

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Introduction At the end of life, patients with dementia often experience high levels of pain due to complex interplay of disease processes and numerous barriers to symptom management. In the hospice setting, informal caregivers play an essential role in pain management. This study describes their experience managing pain in hospice patients with dementia. Methods We conducted a qualitative analysis of audio-recorded interviews with informal caregivers of hospice patients with dementia who had chosen pain as the challenge they wanted to work on within a problem-solving therapy intervention. Results The thematic analysis of sessions with 51 caregivers identified 4 themes: difficulty in communicating with patients, lack of consistent guidance from health-care professionals, perceived uncertainty about the etiology of pain, and secondary suffering. Discussion Our findings indicate the possible need for increased support for caregivers, including educational interventions targeting pain etiology and assessment, and improved communication with health-care professionals.

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“…27 Pain is common in SNFs but under-recognized in patients with dementia. 5 This gap in transitional care is critically important to address given the association of pain to both delirium and functional dependency and subsequent risk for death or permanent institutionalization. Patients with dementia are vulnerable to insults that may be inconsequential to cognitively intact patients because of their more limited cognitive reserve.…”

Section: Discussionmentioning

confidence: 99%

“…3 Inadequate pain management can thwart rehabilitation efforts and dramatically increase costs by its harmful effects on mobility, cognition, healing and mood. 4 In older adults with dementia, pain is frequently unrecognized and under-treated due to a number of complex factors, including inability of patients to verbally communicate the presence of pain 5 and a lack of clear guidance for health care providers on the best approach to treatment in different types of dementia. 3 Inappropriate pain medication was a major source of harm identified in the OIG report.…”

Section: Introductionmentioning

confidence: 99%

Pain, Delirium, and Physical Function in Skilled Nursing Home Patients With Dementia

Kolanowski¹,

Mogle²,

Fick³

et al. 2015

Journal of the American Medical Directors Association

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Objective Skilled Nursing Facilities (SNFs) are major sites of post-acute care for patients with dementia. A recent Office of the Inspector General report indicated that outcomes in SNFs are sub-optimal due to poor-quality treatment, including the failure to provide needed care. Pain is frequently un-recognized and un-treated in patients with dementia. The aim of this exploratory study was to examine the effect daily pain has on delirium and physical function in patients with dementia in SNFs. The association of daily pain with discharge disposition was also examined. Design Secondary analysis of data from an on-going randomized clinical trial. Setting Eight SNFs located in central and northeast Pennsylvania. Participants One hundred and three SNF patients with adjudicated dementia and delirium diagnoses and a mean age of 86 (±6.8) years; most were female (66%) and Caucasian (98%). Measurements Measures of pain (Pain Assessment in Advanced Dementia), delirium (Confusion Assessment Method), and physical function (Barthel Index) were taken daily for 30 days or until discharge. Results On days when participants experienced greater than their average level of pain they also experienced more delirium symptoms (p < .001) and lower physical function (p < .001). Participants with higher levels of average daily pain were more likely to die (OR = 6.306, 95% CI: 1.914–20.771, p = .003) or be placed in a nursing home (OR= 4.77, 95% CI:1.7–13.2, p=.003) compared to returning to the community at 3-month follow-up. Conclusion Greater attention to pain in patients with dementia may be a potential solution to some of the quality problems and high costs of care in SNFs

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Pain and dementia: an overview of the literature

Cited by 55 publications

References 60 publications

Pain management in patients with dementia

Pain management in patients with dementia

Pain in Hospice Patients With Dementia

Pain, Delirium, and Physical Function in Skilled Nursing Home Patients With Dementia

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