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Assessment and treatment of pain in people with dementia

A Correction to this article was published on 28 May 2013

This article has been updated

Abstract

Many elderly people experience pain and regularly take analgesic medication. Pain is also frequent in people with dementia, particularly those with severe disease. As no robust clinical guidelines are available for the treatment of pain in the context of dementia, the risk of inadequate treatment in individuals with this condition is high. Furthermore, our understanding of the aetiology of pain and the potential role of dementia-associated neuropathology in pain is limited. These issues are important in the clinical management of individuals with dementia, as untreated pain is a major contributor to reduced quality of life and disability, and can lead to increased behavioural and psychological symptoms. Assessment scales to identify pain in people with dementia have been highlighted in recent studies, but there is little evidence for consistency between these tools. Numerous studies have evaluated various approaches for the treatment of pain, including stepped-care protocols and/or administration of paracetamol and opioid medications. In this Review, we summarize the best-available evidence regarding the aetiology, assessment and treatment of pain in people with dementia. Further validation of assessment tools and large-scale trials of treatment approaches in people with dementia are needed to improve clinical guidance for the treatment of pain in these individuals.

Key Points

  • Pain is common in people with dementia, and many of these individuals are prescribed analgesic medication

  • Clinical guidance and validated assessment tools to manage and detect pain in patients with dementia are limited, which may lead to inappropriate treatment and/or underdiagnosis of pain in these individuals

  • Evidence to support the hypothesis that dementia-associated neuropathology results in less-frequent or less-severe pain in patients with Alzheimer disease is not robust

  • Practical and simple methods for the assessment of pain in people with dementia are required for use in the clinical setting

  • Evidence is available to support the use of analgesic medication, particularly paracetamol, to address pain in people with dementia

  • Future trials to address pain in patients with dementia should focus on the value of nonpharmacological treatments, stepped-care approaches, and NSAIDs

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Figure 1: Response to acute pain behaviour in mouse models of AD.

Change history

  • 28 May 2013

    In the Review article by Corbett et al. published in the May 2012 issue of Nature Reviews Neurology, some information was omitted from the acknowledgement section. The error has been corrected in the HTML and PDF versions of the article.

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Acknowledgements

The authors would like to thank the Alzheimer’s Society (UK) for supporting the time of Dr Corbett and Professor Ballard to contribute to the review. The authors wish to thank the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre and Dementia Unit at South London, and Maudsley NHS Foundation Trust and Institute of Psychiatry King’s College London for supporting this work. This article presents independent research funded by the NIHR. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

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A. C. Corbett, B. Husebo and C. Ballard contributed equally to researching data for the article, discussion of content, writing, and review and editing of the manuscript before submission. M. Malcangio and J. Cohen-Mansfield researched data for the article, and contributed to discussions of the content and writing the article. A. Staniland researched data for the article and contributed to discussion of the content. D. Aarsland researched data for the article, and contributed to discussion of the content and review and editing of the manuscript before submission.

Corresponding author

Correspondence to Clive Ballard.

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Competing interests

A. Corbett has received consultancy fees from Acadia pharmaceuticals and speakers fees from Lundbeck and Novartis. D. Aarsland has received research grants from GE Healthcare, Lundbeck, Merck Serono and Novartis, and honoraria from DiaGenic, GE Healthcare, GlaxoSmithKline, Lundbeck and Novartis. He is also an advisory board member for DiaGenic. C. Ballard has received research grants from Acadia and Lundbeck pharmaceutical companies, and consultancy fees and honoraria from Acadia, Bristol-Myers Squibb, Esai, Janssen, Lundbeck, Novartis and Shire. J. Cohen-Mansfield, B. Husebo, M. Malcangio and A. Staniland declare no competing interests.

Supplementary information

Supplementary Table 1

Examples of current pain assessment tools for use in people with dementia (DOC 85 kb)

Supplementary Table 2

Treatment studies included in this Review (DOC 61 kb)

Supplementary Box 1

Review criteria search terms (PDF 69 kb)

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Corbett, A., Husebo, B., Malcangio, M. et al. Assessment and treatment of pain in people with dementia. Nat Rev Neurol 8, 264–274 (2012). https://doi.org/10.1038/nrneurol.2012.53

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