Advertisement

Der Nervenarzt

, Volume 83, Issue 4, pp 458–466 | Cite as

Schmerzerfassung bei Demenz

  • H. Bornemann-Cimenti
  • M. Wejbora
  • K. Michaeli
  • C. Kern-Pirsch
  • A. Sandner-KieslingEmail author
Übersichten

Zusammenfassung

Rezente Studien zeigen, dass gerade demente Patienten häufig eine insuffiziente Schmerztherapie erhalten. Als Grund dafür kann zum Teil sicherlich eine geringe Aufklärung des betreuenden Personals über den Einsatz und die Möglichkeiten der Schmerzerfassung bei dementen Patienten postuliert werden.

Selbstbeurteilungsskalen stellen die valideste Methode zur Schmerzevaluation dar und sollten wann immer möglich primär angeboten werden. Beobachtungen der Situation, des Verhaltens und von physiologischen Markern können unterstützend genutzt werden, wenn die kognitiven Fähigkeiten eine Selbstbeurteilung nicht mehr zulassen. Fremdbeurteilungsskalen erleichtern Dokumentation und Verlaufskontrolle.

Schlüsselwörter

Schmerz Schmerzerfassung Demenz Kognitive Einschränkung Schmerzskala 

Pain assessment in patients with dementia

Summary

Recent literature demonstrates that pain in patients with dementia is often undertreated. This can partially be explained by a lack of training in the possibilities of assessing pain in patients with dementia.

Subjective reports are the most valid approach for the assessment of the subjective experience of pain and should therefore be preferred over other methods. The assessment of the context, behavior, and physiological markers is advised if the patient is unable to provide a subjective report. Pain assessment scales are useful for documentation and monitoring.

Keywords

Pain Pain measurement Dementia Cognitive disorders Pain assessment scales 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Danksagung

Die Autoren danken Dr. Margot Glatz, Abteilung für Anästhesiologie und Intensivmedizin Landesklinikum St. Pölten, für ihre wertvollen Anmerkungen zum Thema.

Literatur

  1. 1.
    Ags Panel on Persistent Pain in Older Persons (2002) The management of persistent pain in older persons. J Am Geriatr Soc 50:205–224CrossRefGoogle Scholar
  2. 2.
    Basler HD, Huger D, Kunz R et al (2006) Assessment of pain in advanced dementia. Construct validity of the German PAINAD. Schmerz 20:519–526PubMedCrossRefGoogle Scholar
  3. 3.
    Cohen-Mansfield J (2008) The relationship between different pain assessments in dementia. Alzheimer Dis Assoc Disord 22:86–93PubMedCrossRefGoogle Scholar
  4. 4.
    Denecke H, Hunseler C (2000) Assessment and measurement of pain. Schmerz 14:302–308PubMedCrossRefGoogle Scholar
  5. 5.
    Desbiens NA, Mueller-Rizner N (2000) How well do surrogates assess the pain of seriously ill patients? Crit Care Med 28:1347–1352PubMedCrossRefGoogle Scholar
  6. 6.
    Ferrell BA, Ferrell BR, Rivera L (1995) Pain in cognitively impaired nursing home patients. J Pain Symptom Manage 10:591–598PubMedCrossRefGoogle Scholar
  7. 7.
    Ferrell BR, Novy D, Sullivan MD et al (2001) Ethical dilemmas in pain management. J Pain 2:171–180PubMedCrossRefGoogle Scholar
  8. 8.
    Ferri CP, Prince M, Brayne C et al (2006) Global prevalence of dementia: a Delphi consensus study. Lancet 366:2112–2117CrossRefGoogle Scholar
  9. 9.
    Fischer T (2009) Entwicklung eines Instruments zum Assessment von Schmerzen bei alten Menschen mit schwerer Demenz. In: Medizinische Fakultät Charité – Universitätsmedizin Berlin. Freie Univerisät Berlin, Berlin, S 192Google Scholar
  10. 10.
    Fisher SE, Burgio LD, Thorn BE et al (2002) Pain assessment and management in cognitively impaired nursing home residents: association of certified nursing assistant pain report, Minimum Data Set pain report, and analgesic medication use. J Am Geriatr Soc 50:152–156PubMedCrossRefGoogle Scholar
  11. 11.
    Fuchs-Lacelle S, Hadjistavropoulos T (2004) Development and preliminary validation of the pain assessment checklist for seniors with limited ability to communicate (PACSLAC). Pain Manag Nurs 5:37–49PubMedCrossRefGoogle Scholar
  12. 12.
    Galicia-Castillo MC, Mcelhaney J (2003) Persistent pain in the elderly. Compr Ther 29:43–46PubMedCrossRefGoogle Scholar
  13. 13.
    Gnass I, Sirsch E (2009) Schmerzassessment bei Menschen mit Bewusstseinsbeeinträchtigungen In: Bartholomeyczik S, Halek M (Hrsg) Assessmentinstrumente in der Pflege: Möglichkeiten und Grenzen. Schlüter, Hannover, S 173–184Google Scholar
  14. 14.
    Handel E, Gnass I (2010) Praxishandbuch ZOPA: Schmerzeinschätzung bei Patienten mit kognitiven und/oder Bewusstseinsbeeinträchtigungen. Huber, BernGoogle Scholar
  15. 15.
    Helme RD, Gibson SJ (2001) The epidemiology of pain in elderly people. Clin Geriatr Med 17:417–431PubMedCrossRefGoogle Scholar
  16. 16.
    Herr K, Coyne P, Key T et al (2006) Pain assessment in the nonverbal patient: position statement with clinical practice recommendations. Pain Manag Nurs 7:44–52PubMedCrossRefGoogle Scholar
  17. 17.
    Horgas AL (2003) Pain management in elderly adults. J Infus Nurs 26:161–165PubMedCrossRefGoogle Scholar
  18. 18.
    Kamel HK, Phlavan M, Malekgoudarzi B et al (2001) Utilizing pain assessment scales increases the frequency of diagnosing pain among elderly nursing home residents. J Pain Symptom Manage 21:450–455PubMedCrossRefGoogle Scholar
  19. 19.
    Kunz M, Lautenbacher S (2004) The impact of Alzheimer’s disease on the pain processing. Fortschr Neurol Psychiatr 72:375–382PubMedCrossRefGoogle Scholar
  20. 20.
    Kunz M, Lautenbacher S (2005) Veränderung des Schmerzerlebens bei Alzheimer-Patienten. Z Neuropsychol 16:201–209CrossRefGoogle Scholar
  21. 21.
    Kunz M, Scharmann S, Hemmeter U et al (2007) The facial expression of pain in patients with dementia. Pain 133:221–228PubMedCrossRefGoogle Scholar
  22. 22.
    Lautenbacher S, Kunz M, Strate P et al (2005) Age effects on pain thresholds, temporal summation and spatial summation of heat and pressure pain. Pain 115:410–418PubMedCrossRefGoogle Scholar
  23. 23.
    Lints-Martindale AC, Hadjistavropoulos T, Barber B et al (2007) A psychophysical investigation of the facial action coding system as an index of pain variability among older adults with and without Alzheimer’s disease. Pain Med 8:678–689PubMedCrossRefGoogle Scholar
  24. 24.
    Maier W, Jessen F (2010) Evidence-based standards for care of patients with dementia. The interdisciplinary S 3 guideline for dementia. Nervenarzt 81:795PubMedCrossRefGoogle Scholar
  25. 25.
    Matthews FE, Dening T (2002) Prevalence of dementia in institutional care. Lancet 360:225–226PubMedCrossRefGoogle Scholar
  26. 26.
    Mccaffery M, Pasero C (1999) Pain: clinical manual. Mosby, St. LouisGoogle Scholar
  27. 27.
    Mitchell C (2001) Assessment and management of chronic pain in elderly people. Br J Nurs 10:296–304PubMedGoogle Scholar
  28. 28.
    Pergolizzi J, Boger RH, Budd K et al (2008) Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract 8:287–313PubMedCrossRefGoogle Scholar
  29. 29.
    Pinter G, Likar R, Anditsch M et al (2010) Problems of pain measurement and pain therapy in the elderly. Wien Med Wochenschr 160:235–246PubMedCrossRefGoogle Scholar
  30. 30.
    Rainero I, Vighetti S, Bergamasco B et al (2000) Autonomic responses and pain perception in Alzheimer’s disease. Eur J Pain 4:267–274PubMedCrossRefGoogle Scholar
  31. 31.
    Rodriguez CS (2001) Pain measurement in the elderly: a review. Pain Manag Nurs 2:38–46PubMedCrossRefGoogle Scholar
  32. 32.
    Ruoff GE (2002) Challenges of managing chronic pain in the elderly. Semin Arthritis Rheum 32:43–50PubMedCrossRefGoogle Scholar
  33. 33.
    Scherder EJ, Bouma A (1997) Is decreased use of analgesics in Alzheimer disease due to a change in the affective component of pain? Alzheimer Dis Assoc Disord 11:171–174PubMedCrossRefGoogle Scholar
  34. 34.
    Scherder EJA, Sergeant JA, Swaab DF (2003) Pain processing in dementia and its relation to neuropathology. Lancet Neurol 2:677–686PubMedCrossRefGoogle Scholar
  35. 35.
    Schuler M, Neuhauser T, Hauer K et al (2001) Recognizing pain in geriatric patients by an interdisciplinary team. Reliability of judgment and factors of influence. Z Gerontol Geriatr 34:376–386PubMedCrossRefGoogle Scholar
  36. 36.
    Schuler MS, Becker S, Kaspar R et al (2007) Psychometric properties of the German „Pain Assessment in Advanced Dementia Scale“ (PAINAD-G) in nursing home residents. J Am Med Dir Assoc 8:388–395PubMedCrossRefGoogle Scholar
  37. 37.
    Schwermann M, Münch M (2008) Professionelles Schmerzassessment bei Menschen mit Demenz: ein Leitfaden für die Pflegepraxis. Kohlhammer, StuttgartGoogle Scholar
  38. 38.
    Shega JW, Hougham GW, Stocking CB et al (2006) Management of noncancer pain in community-dwelling persons with dementia. J Am Geriatr Soc 54:1892–1897PubMedCrossRefGoogle Scholar
  39. 39.
    Shega JW, Hougham GW, Stocking CB et al (2004) Pain in community-dwelling persons with dementia: frequency, intensity, and congruence between patient and caregiver report. J Pain Symptom Manage 28:585–592PubMedCrossRefGoogle Scholar
  40. 40.
    Snow AL, O’malley K J, Cody M et al (2004) A conceptual model of pain assessment for noncommunicative persons with dementia. Gerontologist 44:807–817PubMedCrossRefGoogle Scholar
  41. 41.
    Stewart M, Verkerk GA, Stafford KJ et al (2010) Noninvasive assessment of autonomic activity for evaluation of pain in calves, using surgical castration as a model. J Dairy Sci 93:3602–3609PubMedCrossRefGoogle Scholar
  42. 42.
    Warden V, Hurley AC, Volicer L (2003) Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc 4:9–15PubMedCrossRefGoogle Scholar
  43. 43.
    Werner P, Cohen-Mansfield J, Watson V et al (1998) Pain in participants of adult day care centers: assessment by different raters. J Pain Symptom Manage 15:8–17PubMedCrossRefGoogle Scholar
  44. 44.
    Wilson J, O’donnell M, Mcauliffe L et al (2008) Assessment of pain in older adults with dementia in acute, sub acute and residential care (Systematic review). Australian Centre for Evidence Based Aged Care, La Trobe UnivGoogle Scholar
  45. 45.
    Wynne CF, Ling SM, Remsburg R (2000) Comparison of pain assessment instruments in cognitively intact and cognitively impaired nursing home residents. Geriatr Nurs 21:20–23PubMedCrossRefGoogle Scholar
  46. 46.
    Zwakhalen SM, Hamers JP, Abu-Saad HH et al (2006) Pain in elderly people with severe dementia: a systematic review of behavioural pain assessment tools. BMC Geriatr 6:3PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • H. Bornemann-Cimenti
    • 1
  • M. Wejbora
    • 1
  • K. Michaeli
    • 1
  • C. Kern-Pirsch
    • 1
  • A. Sandner-Kiesling
    • 1
    Email author
  1. 1.Universitätsklinik für Anästhesiologie und IntensivmedizinMedizinische Universität GrazGrazÖsterreich

Personalised recommendations