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Effective Pain Management in Patients with Dementia: Benefits Beyond Pain?

Drugs & Aging volume 31, pages 863–871 (2014)Cite this article

Abstract

This current opinion aims to provide a literature overview of the associations between pain and neuropsychiatric symptoms and the efficacy of pain management for both pain and neuropsychiatric symptoms in patients with dementia. In addition, international guidelines and recommendations for pain management have been collated, and important developing research areas are highlighted. Pain is, in general, under-recognized and undertreated in people with dementia and may therefore trigger or exacerbate neuropsychiatric symptoms. While there is an abundance of pain assessment instruments intended for people with dementia, few have been adequately tested for their feasibility, reliability and validity. In patients with dementia, vocalizations, facial expressions and body movements may be the only valid expressions of pain. Further, pain has been related to the neuropsychiatric symptoms of agitation, aggression, mood syndrome and sleep problems. Unfortunately, health personnel may misinterpret these symptoms as neuropsychiatric symptoms of dementia. A differential assessment of dementia, its presenting neuropsychiatric symptoms and the potential presence of pain is crucial to provide the correct treatment. To achieve this, use of pain assessment tools that are responsive to change and are validated for use in patients with dementia is a prerequisite. To date, there have been few studies, with inconsistent findings on the association between pain and neuropsychiatric symptoms. To ensure a better differential assessment of pain and neuropsychiatric symptoms, and consequently more accurate treatment for patients with dementia, studies with adequate statistical power and high-quality study designs, including randomized controlled trials, are needed.

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Acknowledgments

We would like to thank the G.C. Rieber Foundation for supporting our work at the Centre for Elderly and Nursing Home Medicine, University of Bergen, Norway.

E.F. and B.S.H. are members of the EU-COST-Action TD 1005: Pain Assessment in Patients with Cognitive Impairment, especially Dementia.

E.F. and C.G. have received a postdoctoral grant and a PhD grant, respectively, from the Norwegian Research Council.

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  1. Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Pbox 7800, 5020, Bergen, Norway

    Elisabeth Flo, Christine Gulla & Bettina S. Husebo

  2. Stavanger University Hospital, Stavanger, Norway

    Bettina S. Husebo

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  1. Elisabeth Flo
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  2. Christine Gulla
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Correspondence to Elisabeth Flo.

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Flo, E., Gulla, C. & Husebo, B.S. Effective Pain Management in Patients with Dementia: Benefits Beyond Pain?. Drugs Aging 31, 863–871 (2014). https://doi.org/10.1007/s40266-014-0222-0

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Keywords

  • Dementia
  • Pain Management
  • Pain Assessment
  • Pain Treatment
  • Neuropsychiatric Symptom