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Übersichtsartikel

Pain Assessment and Treatment Challenges in Patients with Dementia

1This article is a modified version of the article „Pain in patients with dementia: An overview of pain assessment and treatment challenges” that will be printed in the Journal of Norsk Epidemiologi.

Published Online:November 27, 2012https://doi.org/10.1024/1016-264X/a000078

Abstract

Pain is likely to be equally prevalent in people with dementia, however, only a small minority are prescribed regular analgesics. This is a key issue since untreated pain leads to reduced quality of life and increases the likelihood of emergence of behavioural and psychological symptoms such as agitation. Better assessment and treatment of pain in this fragile patient group are therefore mandatory. In this context, we reviewed the literature on pain and dementia and summarised the best available evidence regarding the frequency of pain and pain diagnosis. Unfortunately, hardly any randomized, controlled studies of pain treatment efficacy in patients with dementia are available, with the consequence that most pain treatment recommendations are not based on the highest level of evidence.


Herausforderungen bei der Erfassung und Behandlung von Schmerzen bei Patienten mit demenzieller Erkrankung

Schmerz ist bei Personen mit Demenz wahrscheinlich ebenso häufig  wie sonst, jedoch werden nur wenigen Patienten Analgetika verschrieben. Das ist ein zentrales Problem, weil unbehandelte Schmerzen die Entwicklung von Verhaltensstörungen und psychischen Symptomen wie Agitiertheit begünstigen. Eine bessere Messung und Behandlung  von Schmerzen bei diesen besonders gebrechlichen Personen ist daher dringend geboten. In diesem Zusammenhang haben wir die Literatur gesichtet und die bestmögliche Evidenz zur Prävalenz von Schmerzen und das Vorgehen in der Schmerzdiagnostik zusammengestellt. Leider gibt es bislang kaum Studien mit randomisiertem Kontrollgruppendesign, so dass die meisten Empfehlungen zur Schmerzbehandlung bei Demenz nicht höchstes Evidenzniveau aufweisen.

References

  • Achterberg, W. P. , Pot, A. M. , Scherder, E. J. & Ribbe, M.W. (2007). Pain in the nursing home: Assessment and treatment on different types of care wards. Journal of Pain and Symptom Management, 34, 480 – 487. First citation in articleCrossref, Google Scholar

  • AGS Panel. (2009). Pharmacological Management of Persistent Pain in Older Persons. Journal of American Geriatric Society, 57, 1331 – 1366. First citation in articleCrossref, Google Scholar

  • AGS Panel. (1998). The management of chronic pain in older persons. Journal of American Geriatric Society, 46, 635 – 651. First citation in articleCrossref, Google Scholar

  • AGS Panel. (2002). The management of persistent pain in older persons. Journal of the American Geriatric Society, 50, 205 – 224. First citation in articleCrossref, Google Scholar

  • Ballard, C. , Smith, J. , Husebo, B. S. , Aarsland, D. & Corbett, A. (2011). The role of pain treatment in managing the behavioural and psychological symptoms of dementia (BPSD). International Journal of Palliative Nursing, 17, 420 – 423. First citation in articleCrossref, Google Scholar

  • Black, B. S. , Finucane, T. , Baker, A. , Loreck, D. , Blass, D. , Fogarty, L. et al. (2006). Health problems and correlates of pain in nursing home residents with advanced dementia. Alzheimer Disease and Associated Disorders, 20, 283 – 290. First citation in articleCrossref, Google Scholar

  • Bosley, B. N. , Weiner, D. K. , Rudy, T. E. & Granieri, E. (2004). Is chronic nonmalignant pain associated with decreased appetite in older adults? Preliminary evidence. Journal of the American Geriatric Society, 52, 247 – 251. First citation in articleCrossref, Google Scholar

  • Buffum, M. D. & Haberfelde, M. (2007). Moving to new settings: Pilot study of families’ perceptions of professional caregivers’ pain management in persons with dementia. Journal of Rehabilitation and Research Development, 44, 295 – 303. First citation in articleCrossref, Google Scholar

  • Cipher, D. J. & Clifford, R. A. (2004). Dementia, pain, depression, behavioral disturbances, and ADLs: toward a comprehensive conceptualization of quality of life in long-term care. International Journal of Geriatric Psychiatry, 19, 741 – 748. First citation in articleCrossref, Google Scholar

  • Closs, S. J. , Barr, B. & Briggs, M. (2004). Cognitive status and analgesic provision in nursing home residents. British Journal of General Practice, 54, 919 – 921. First citation in articleGoogle Scholar

  • Cohen-Mansfield, J. (2006). Pain Assessment in Noncommunicative Elderly Persons – PAINE. Clinical Journal of Pain, 22, 569 – 575. First citation in articleCrossref, Google Scholar

  • Corbett, A. , Husebo, B. S. , Malcangio, M. , Staniland, A. , Cohen-Mansfield, J. , Aarsland, D. et al. (2012). Assessment and treatment of pain in people with dementia Assessment, diagnosis and treatment of pain in people with dementia. Nature Reviews Neurology, 8, 264 – 274. First citation in articleCrossref, Google Scholar

  • Cordner, Z. , Blass, D. M. , Rabins, P. V. & Black, B. S. (2010). Quality of Life in Nursing Home Residents with Advanced Dementia. Journal of the American Geriatric Society, 58, 2394 – 2400. First citation in articleCrossref, Google Scholar

  • Cramer, G. W. , Galer, B. S. , Mendelson, M. A. & Thomson, G. D. (2000). A drug use evaluation of selected opioid and nonopioid analgesics in the nursing facility setting. Journal of the American Geriatric Society, 48, 398 – 404. First citation in articleCrossref, Google Scholar

  • Ekman, P. & Friesen, W. V. (1978). Facial action coding system: Investigator’s guide. Palo Alto, California: Consulting Psychologists Press. First citation in articleGoogle Scholar

  • Elseviers, M. M. , Vander Stichele, R. R. & Van Bortel, L. (2010). Drug utilization in Belgian nursing homes: impact of residents’ and institutional characteristics. Pharmacoepidemiology and Drug Safety, 190, 1041 – 1048. First citation in articleCrossref, Google Scholar

  • Ferrell, B. A. (1991). Pain Management in Elderly People. Journal of the American Geriatric Society, 39, 64 – 73. First citation in articleCrossref, Google Scholar

  • Ferrell, B. R. & Griffith, H. (1994). Cost Issues Related to Pain Management – Report from the Cancer Pain Panel of the Agency for Health-Care Policy and Research. Journal of Pain and Symptom Management, 9, 221 – 234. First citation in articleCrossref, Google Scholar

  • Fuchs-Lacelle, S. & Hadjistavropoulos, T. (2004). Development and preliminary validation of pain assessment checklist for seniors with limited ability to communicate (PACSLAC). Pain Management Nursing, 5, 37 – 49. First citation in articleCrossref, Google Scholar

  • Giron, M. S. T. , Forsell, Y. , Bernsten, C. , Thorslund, M. , Winblad, B. & Fastbom, J. (2002). Sleep problems in a very old population: Drug use and clinical correlates. Journals of Gerontology A-Biological Science and Medical Science, 57, 236 – 240. First citation in articleCrossref, Google Scholar

  • Gloth, F. M. (2011). Pharmacological Management of Persistent Pain in Older Persons: Focus on Opioids and Nonopioids. Journal of Pain, 12, 14 – 20. First citation in articleCrossref, Google Scholar

  • Gluhak, C. , Arnetzl, G. V. , Kirmeier, R. , Jakse, N. & Arnetzl, G. (2010). Oral status among seniors in nine nursing homes in Styria, Austria. Gerontology, 27, 47 – 52. First citation in articleGoogle Scholar

  • Grimby, C. , Fastbom, J. , Forsell, Y. , Thorslund, M. , Claesson, C.B. & Winblad, B. (1999). Musculoskeletal pain and analgesic therapy in a very old population. Archives of Gerontology and Geriatrics, 29, 29 – 43. First citation in articleCrossref, Google Scholar

  • Haasum, Y. , Fastbom, J. , Fratiglioni, L. , Kåreholt, I. & Johnell, K. (2011). Pain Treatment in Elderly Persons With and Without Dementia A Population-Based Study of Institutionalized and Home-Dwelling Elderly. Drugs and Aging, 28, 283 – 293. First citation in articleCrossref, Google Scholar

  • Hadjistavropoulos, T. , Herr, K. , Turk, D. C. , Fine, P. G. , Dworkin, R. H. , Helme, R. et al. (2007). An interdisciplinary expert consensus statement on assessment of pain in older persons. Clinical Journal of Pain, 23, S1-S43. First citation in articleCrossref, Google Scholar

  • Helme, R. D. & Gibson, S. J. (2001).The epidemiology of pain in elderly people. Clinics in Geriatric Medicine, 17, 417 – 431. First citation in articleCrossref, Google Scholar

  • Herkenning en behandeling van pijn bij kwetsbare ouderen (Richtlijn Pijn). Verenso, 2011. http://www.anesthesiologie.nl/uploads/108/1193/Def_RL_Pijn_bij_Kwetsbare_Ouderen_2011.pdf First citation in articleGoogle Scholar

  • Herr, K. , Bjoro, K. & Decker, S. (2006). Tools for assessment of pain in nonverbal older adults with dementia: A state-of-the-science review. Journal of Pain and Symptom Management, 31, 170 – 192. First citation in articleCrossref, Google Scholar

  • Herr, K. (2011). Pain Assessment Strategies in Older Patients. Journal of Pain, 12, 3 – 13. First citation in articleCrossref, Google Scholar

  • Horn, S. D. , Bender, S. A. , Bergstrom, N. , Cook, A. S. , Ferguson, M. L. , Rimmasch, H. L. et al. (2002). Description of the National Pressure Ulcer Long-Term Care Study. Journal of the American Geriatric Society, 50, 1816 – 1825. First citation in articleCrossref, Google Scholar

  • Husebo, B. S. , Ballard, C. & Aarsland, D. (2011). Pain treatment of agitation in patients with dementia: a systematic review. International Journal of Geriatric Psychiatry, 26, 1012 – 1028. First citation in articleCrossref, Google Scholar

  • Husebo, B. S. , Ballard, C. , Sandvik, R. , Nilsen, O. B. & Aarsland, D. (2011). Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial. British Medical Journal, 343, 1 – 10. First citation in articleCrossref, Google Scholar

  • Husebo, B. S. , Strand, L. I. , Moe-Nilssen, R. , Husebo, S.B. , Snow, A.L. & Ljunggren, A.E. (2007). Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale (MOBID): Development and Validation of a Nurse-Administered Pain Assessment Tool for Use in Dementia. Journal of Pain and Symptom Management, 34, 67 – 80. First citation in articleCrossref, Google Scholar

  • Husebo, B. S. , Strand, L. I. , Moe-Nilssen, R. , Husebo, S.B. & Ljunggren, A.E. (2009). Pain behaviour and pain intensity in older persons with severe dementia: reliability of the MOBID Pain Scale by video uptake. Scandinavian Journal of Caring Sciences, 24, 380 – 391. First citation in articleCrossref, Google Scholar

  • Husebo, B. S. , Strand, L. I. , Moe-Nilssen, R. , Husebo, S.B. & Ljunggren, A.E. (2010). Pain in older persons with severe dementia. Psychometric properties of the Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID-2) Pain Scale in a clinical setting. Scandinavian Journal of Caring Sciences, 24, 380 – 391. First citation in articleCrossref, Google Scholar

  • Husebo, B. S. , Strand, L. I. , Moe-Nilssen, R. , Borgehusebo, S. , Aarsland, D. & Ljunggren, A. E. (2008). Who suffers most? Dementia and pain in nursing home patients: A cross-sectional study. Journal of the American Directors Association, 9, 427 – 433. First citation in articleCrossref, Google Scholar

  • Jakobsson, U. & Hallberg, I. R. (2002). Pain and quality of life among older people with rheumatoid arthritis and/or osteoarthritis: a literature review. Journal of Clinical Nursing, 11, 430 – 443. First citation in articleCrossref, Google Scholar

  • Kappesser, J. , Williams, A.C. & Prkachin, K.M. (2006). Testing two accounts of pain underestimation. Pain, 124, 109 – 116. First citation in articleCrossref, Google Scholar

  • Koopman, J. S. , Dieleman, J. P. , Huygen, F. J. , de Mos, M. , Martin, C.G. & Sturkenboom, M.C. (2009). Incidence of facial pain in the general population. Pain, 147, 122 – 127. First citation in articleCrossref, Google Scholar

  • Kunz, M. , Scharmann, S. , Hemmeter, U. , Schepelmann, K. & Lautenbacher, S. (2007). The facial expression of pain in patients with dementia. Pain, 133, 221 – 228. First citation in articleCrossref, Google Scholar

  • Leong,I. Y. & Nuo, T. H. (2007). Prevalence of pain in nursing home residents with different cognitive and communicative abilities. Clinical Journal of Pain, 23, 119 – 127. First citation in articleGoogle Scholar

  • Lefebvre-Chapiro, S. (2001). The Doloplus 2 scale – evaluating pain in the elderly. European Journal of Palliative Care, 8, 191 – 194. First citation in articleGoogle Scholar

  • Lin, P. C. , Lin, L. C. , Shyu, Y. I. L. & Hua, M. S. (2011). Predictors of pain in nursing home residents with dementia: a cross-sectional study. Journal of Clinical Nursing, 20, 1849 – 1857. First citation in articleCrossref, Google Scholar

  • Lobbezoo, F. , Weijenberg, R. A. F. & Scherder, E. J. A. (2011). Topical Review: Orofacial Pain in Dementia Patients. A Diagnostic Challenge. Journal of Orofacial Pain, 25, 6 – 14. First citation in articleGoogle Scholar

  • Lovheim, H. , Karlsson, S. & Gustafson, Y. (2008). The use of central nervous system drugs and analgesics among very old people with and without dementia. Pharmacoepidemiology of Drug Safety, 17, 912 – 918. First citation in articleCrossref, Google Scholar

  • Miro, J. , Paredes, S. , Rull, M. , Queral, R. , Miralles, R. , Nieto, R. et al. (2007). Pain in older adults: A prevalence study in the Mediterranean region of Catalonia. European Journal of Pain, 11, 83 – 92. First citation in articleCrossref, Google Scholar

  • Moriarty, O. M. , McGuire, B. E. & Finn, D. P. (2011). The effect of pain on cognitive function: A review of clinical and preclinical research. Progress in Neurobiology, 93, 385 – 404. First citation in articleCrossref, Google Scholar

  • Nygaard, H. A. & Jarland, M. (2005). Are nursing home patients with dementia diagnosis at increased risk for inadequate pain treatment? International Journal of Geriatric Psychiatry, 20, 730 – 737. First citation in articleCrossref, Google Scholar

  • Nygaard, H. A. & Jarland, M. (2006). The Checklist of Nonverbal Pain Indicators (CNPI): testing of reliability and validity in Norwegian nursing homes. Age and Ageing, 35, 79 – 81. First citation in articleCrossref, Google Scholar

  • Pautex, S. , Michon, A. , Guedira, M. , Emond, H. , Le Lous, P. , Samaras, D. et al. (2006).Pain in severe dementia: self-assessment or observational scales? Journal of the American Geriatric Society, 54, 1040 – 1045. First citation in articleCrossref, Google Scholar

  • Prkachin, K. M. (1992). The Consistency of Facial Expressions of Pain – A Comparison Across Modalities, Pain, 51, 297 – 306. First citation in articleCrossref, Google Scholar

  • Richards, S. C. M. & Scott, D. L. (2002). Prescribed exercise in people with fibromyalgia: parallel group randomised controlled trial. British Medical Journal, 325, 185 – 187. First citation in articleCrossref, Google Scholar

  • Scherder, E. , Herr, K. , Pickering, G. , Gibson, S. , Benedetti, F. & Lautenbacher, S. (2009). Pain in dementia. Pain, 145, 276 – 768. First citation in articleCrossref, Google Scholar

  • Snow, A. L. , Weber, J. B. , O’Malley, K. J. , Cody, M. , Beck, C. , Bruera, E. et al. (2004). NOPPAIN: A nursing assistant-administered pain assessment instrument for use in dementia. Dementia and Geriatric Cognitive Disorders, 17, 240 – 246. First citation in articleCrossref, Google Scholar

  • Takai, Y. , Yamamoto-Mitani, N. , Okamoto, Y. , Koyama, K. & Honda, A. (2010). Literature Review of Pain Prevalence Among Older Residents of Nursing Homes. Pain Management Nursing, 11, 209 – 223. First citation in articleCrossref, Google Scholar

  • Tambyah, P. A. & Maki, D. G. (2000). Catheter-associated urinary tract infection is rarely symptomatic – A prospective study of 1497 catheterized patients. Archives of Internal Medicine, 160, 678 – 682. First citation in articleGoogle Scholar

  • Tse, M. M. Y. , Pun, S. P. Y. & Benzie, I. F. F. (2005). Pain relief strategies used by older people with chronic pain: an exploratory survey for planning patient-centred intervention. Journal of Clinical Nursing, 14, 315 – 320. First citation in articleCrossref, Google Scholar

  • Villanueva, M. R. (2003). Pain assessment for the dementing elderly (PADE): Reliability and validity of a new measure. Journal of the American Medical Directors Association, 4, 1. – 8. First citation in articleCrossref, Google Scholar

  • Warden, V. , Hurley, A. C. & Volicer, L. (2003). Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. Journal of the American Medical Directors Association, 4, 9 – 15. First citation in articleCrossref, Google Scholar

  • Won, A. B. , Lapane, K. , Vallow, S. , Schein, J. , Morris, J.N. & Lipsitz, L.A. (2003). Persistent nonmalignant pain and analgesic prescribing practices in elderly nursing home residents. Journal of the American Geriatric Society, 51, 193 – 194. First citation in articleGoogle Scholar

  • Woolf, A. D. , Zeidler, H. , Haglund, U. , Carr, A.J. , Chaussade, S. , Cucinotta, D. et al. (2004). Musculoskeletal pain in Europe: its impact and a comparison of population and medical perceptions of treatment in eight European countries. Annals of the Rheumatic Diseases, 63, 342 – 347. First citation in articleCrossref, Google Scholar

  • Wroblewski, M. & Mikulowski, P. (1991). Peritonitis in Geriatric Inpatients. Age and Ageing, 20, 90 – 94. First citation in articleCrossref, Google Scholar

  • Zwakhalen, S. M. , Hamers, J. P. , Abu-Saad, H. H. & Berger, M. P. (2006). Pain in elderly people with severe dementia: a systematic review of behavioural pain assessment tools. BMC Geriatrics, 6, 3. First citation in articleGoogle Scholar

  • Zwakhalen, S. M. , Koopmans, R. T. , Geels, P. J. , Berger, M. P. & Hamers, J. P. (2009). The prevalence of pain in nursing home residents with dementia measured using an observational pain scale. European Journal of Pain, 13, 89 – 93. First citation in articleCrossref, Google Scholar