An interdisciplinary approach includes comprehensive assessment, managing polypharmacy and pharmacotherapy, psychological evaluation and support, physical rehabilitation, and interventions and interventional procedures. Organizations invested in an interdisciplinary team approach to managing the problems associated with dementia are best prepared to gather information that informs the treatment plan and engages individuals most likely to be effective in implementing the pain management plan.
Challenges of creating a functional interdisciplinary team need to be addressed by the organization to promote use of nondrug therapies and establish reimbursement for multiple providers and nondrug therapies for pain management. Pain is a challenge for persons with dementia, their loved ones, health care professionals, and society.
Although in the past decade better assessment procedures including observational pain instruments have been developed and studied, implementation in practice is still disappointing. Good pain management is unfortunately also not implemented, which this is partly due to a lack of good studies on both pharmacological and nonpharmacological management. To effectively assess and manage pain in this vulnerable group, interdisciplinary collaboration nurses, physicians, psychologists, computer scientists, and engineers is essential.
This article provides the latest state of the literature on this topic. Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. Pain Rep. Published online Dec Author information Article notes Copyright and License information Disclaimer.
E-mail address: ln. Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4. This article has been cited by other articles in PMC. Abstract The ageing revolution is changing the composition of our society with more people becoming very old with higher risks for developing both pain and dementia. Key Points Pain in dementia is very prevalent and difficult to assess.
Next to easy self-report measures, observational instruments are necessary in clinical practice. Nonpharmacological management programs are the first line of choice, often in combination with analgesics. Epidemiology 1. The demographic revolution puts pain in dementia in the spotlight In the 20th century, the world population has seen an incredible growth in life expectancy. What do we know of pain in the different subtypes of dementia?
To know what the effects of pain are in different subtypes of dementia, several things have to be taken into account: 1 The more general problems that arise in most type of dementias, such as difficulty in abstract thinking and verbal communication, and. Prevalence of pain in dementia In the community, more than half of the patients with dementia experience daily pain.
Consequences of pain in dementia There is some evidence that pain in dementia is related to a variety of behavioural symptoms, such as depression, verbal abuse, wandering, agitation, and aggression. Pain assessment in patients with dementia Competent pain assessment is a necessary prerequisite for good pain management and ideally considers several pain dimensions, namely intensity, location, affect, cognition, behavior, and social accompaniments. Self-report The gold standard in pain assessment is the self-report either in less standardized forms as asked in interviews or in more standardized forms as requested in pain scales.
Observer ratings There is general agreement that observer ratings of pain organized in short scales are necessary in moderate and severe forms of dementia to get valid and reliable information about the presence and intensity of pain. Table 1 Survey of the most frequently used observational scales according to Zwakhalen et al. Open in a separate window. Experimental methods Experimental methods such as pain psychophysics eg, pain threshold and tolerance threshold , brain imaging, neurophysiologic recordings eg, SSEP and R-III reflex , and facial response coding are not easily used in the clinical context for pain assessment and are mainly reserved for research on individuals with dementia.
Automatic pain recognition The technical attempts of finding solutions to the problem of automatic pain recognition are meanwhile numerous and seem to be ideal for assisting pain measurement in noncommunicative nonverbal individuals. New developments in nonpharmacological management Complexities of pain in older persons with dementia necessitate a comprehensive pain management approach that encompasses more than pharmacotherapy.
Table 2 Most promising nonpharmacologic interventions for use in dementia. Nonsteroidal anti-inflammatory drugs Long-term use of nonsteroidal anti-inflammatory drugs NSAIDs is associated with increased risk of potentially serious adverse events, and should be avoided. Opioids Opioid analgesics are commonly prescribed for noncancer acute or chronic pain in people with dementia, and their use in this population has rapidly increased over the past decades.
Adjuvant analgesics No clinical trials have investigated the safety and efficacy of adjuvant analgesics such as antidepressants and antiepileptic drugs for treating pain in dementia. Unresolved issues Several important unresolved issues remain in relation to current guidelines and practice for the use of analgesic drugs in people with dementia. Interdisciplinary pain management and implementation in long term care As with any patient with persistent pain, development of a comprehensive treatment plan is essential and, in the population of dementia, in particular, an interdisciplinary approach is key to establishment of a multimodal pain management plan.
Conclusion Pain is a challenge for persons with dementia, their loved ones, health care professionals, and society. Disclosures The authors have no conflicts of interest to declare. Footnotes Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia.
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Eur J Pain ; 18 — Analgesic prescribing patterns in Norwegian nursing homes from to trend analyses of four data samples. Age Ageing ; 45 — Pain processing in dementia and its relation to neuropathology. Topics covered include the forces that cause exchange rates to fluctuate, an overview of the mechanics of trading, analytical and forecasting tools, how to profit from pricing trends, and common pitfalls that often ensnare traders. While most books make grandiose promises of instant success and large profits, Forex for Beginners represents an alternative approach to investing in forex.
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