Pain management in patients with dementia

Wilco P Achterberg,1 Marjoleine JC Pieper,2 Annelore H van Dalen-Kok,1 Margot WM de Waal,1 Bettina S Husebo,3 Stefan Lautenbacher,4 Miriam Kunz,4 Erik JA Scherder,5 Anne Corbett6 1Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, 2Department of General Practice...

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Autores principales:	Achterberg WP, Pieper MJC, van Dalen-Kok AH, de Waal MWM, Husebo BS, Lautenbacher S, Kunz M, Scherder EJA, Corbett A
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2013
Materias:	Pain assessment pain management dementia Alzheimer’s Disease cognitive impairment Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/de0e0c1f71ec459096fd9e1ef066fd0e
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spelling	oai:doaj.org-article:de0e0c1f71ec459096fd9e1ef066fd0e2021-12-02T01:19:49ZPain management in patients with dementia1178-1998https://doaj.org/article/de0e0c1f71ec459096fd9e1ef066fd0e2013-11-01T00:00:00Zhttps://www.dovepress.com/pain-management-in-patients-with-dementia-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Wilco P Achterberg,1 Marjoleine JC Pieper,2 Annelore H van Dalen-Kok,1 Margot WM de Waal,1 Bettina S Husebo,3 Stefan Lautenbacher,4 Miriam Kunz,4 Erik JA Scherder,5 Anne Corbett6 1Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, 2Department of General Practice and Elderly Care Medicine, VU University Medical Center Amsterdam, Amsterdam, The Netherlands; 3Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; 4Physiological Psychology, Otto Friedrich University Bamberg, Bamberg, Germany; 5Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands; 6Wolfson Centre for Age-Related Diseases, King's College London, London, UK Abstract: 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. Keywords: pain assessment, Alzheimer's disease, cognitive impairment, behaviorAchterberg WPPieper MJCvan Dalen-Kok AHde Waal MWMHusebo BSLautenbacher SKunz MScherder EJACorbett ADove Medical PressarticlePain assessmentpain managementdementiaAlzheimer’s Diseasecognitive impairmentGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 8, Pp 1471-1482 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Pain assessment pain management dementia Alzheimer’s Disease cognitive impairment Geriatrics RC952-954.6
spellingShingle	Pain assessment pain management dementia Alzheimer’s Disease cognitive impairment Geriatrics RC952-954.6 Achterberg WP Pieper MJC van Dalen-Kok AH de Waal MWM Husebo BS Lautenbacher S Kunz M Scherder EJA Corbett A Pain management in patients with dementia
description	Wilco P Achterberg,1 Marjoleine JC Pieper,2 Annelore H van Dalen-Kok,1 Margot WM de Waal,1 Bettina S Husebo,3 Stefan Lautenbacher,4 Miriam Kunz,4 Erik JA Scherder,5 Anne Corbett6 1Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, 2Department of General Practice and Elderly Care Medicine, VU University Medical Center Amsterdam, Amsterdam, The Netherlands; 3Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; 4Physiological Psychology, Otto Friedrich University Bamberg, Bamberg, Germany; 5Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands; 6Wolfson Centre for Age-Related Diseases, King's College London, London, UK Abstract: 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. Keywords: pain assessment, Alzheimer's disease, cognitive impairment, behavior
format	article
author	Achterberg WP Pieper MJC van Dalen-Kok AH de Waal MWM Husebo BS Lautenbacher S Kunz M Scherder EJA Corbett A
author_facet	Achterberg WP Pieper MJC van Dalen-Kok AH de Waal MWM Husebo BS Lautenbacher S Kunz M Scherder EJA Corbett A
author_sort	Achterberg WP
title	Pain management in patients with dementia
title_short	Pain management in patients with dementia
title_full	Pain management in patients with dementia
title_fullStr	Pain management in patients with dementia
title_full_unstemmed	Pain management in patients with dementia
title_sort	pain management in patients with dementia
publisher	Dove Medical Press
publishDate	2013
url	https://doaj.org/article/de0e0c1f71ec459096fd9e1ef066fd0e
work_keys_str_mv	AT achterbergwp painmanagementinpatientswithdementia AT piepermjc painmanagementinpatientswithdementia AT vandalenkokah painmanagementinpatientswithdementia AT dewaalmwm painmanagementinpatientswithdementia AT husebobs painmanagementinpatientswithdementia AT lautenbachers painmanagementinpatientswithdementia AT kunzm painmanagementinpatientswithdementia AT scherdereja painmanagementinpatientswithdementia AT corbetta painmanagementinpatientswithdementia
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Pain management in patients with dementia

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