A Systematic Review of Barriers and Facilitators of Pain Management in Persons with Dementia

Liao, Yo-Jen; Jao, Ying-Ling; Berish, Diane; Hin, Angelina Seda; Wangi, Karolus; Kitko, Lisa; Mogle, Jacqueline; Boltz, Marie

doi:10.1016/j.jpain.2022.12.014

Cited by 8 publications

(3 citation statements)

References 50 publications

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“…If there were more than two predictors of dementia, there was a greater risk for dementia. In a systematic review on 26 studies of people with dementia, 50% of the dementia patients experienced pain [7]. Given that most of the studies were cross-sectional, the directionality of dementia leading to pain or pain leading to dementia is unknown.…”

Section: Effects Of Dementia Disordersmentioning

confidence: 99%

Dementia Disorders: A Narrative Review

Field

2024

J Clin Psychol Neurol

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This narrative review of research includes summaries of 40 papers on dementia disorders that were published during 2023. The publications of this period are primarily randomized controlled trials and systematic reviews/ meta-analyses of randomized controlled trials. A few of these are focused on the prevalence of dementia which approximated one per cent of the world’s population. Only a few studies focused on effects of dementia disorders including memory loss, discrimination, pain, depression and suicidality. Most of the studies addressed predictors of dementia disorders including neurotic personality, frequent tv/computer use and excessive exposure to metals. Loss of short-term memory and other negative experiences including negative life events, loneliness, stress and depression were also significant predictor variables in this recent literature. Physical conditions that were predictive of dementia included pain, hypertension, atrial fibrillation, multi-morbidities, inflammation, encephalitis and neuropathology. Potential underlying mechanisms included dysfunctional neurotransmitter systems (serotonergic, noradrenergic and dopaminergic) and gray matter loss in prefrontal, temporal and other regions associated with memory. Several research groups reported on effective interventions including a Mediterranean diet, plant-based diets, medicinal plants, psychedelics, second generation antidepressants, blood pressure medication, music therapy, aromatherapy and other alternative therapies. Methodological problems relate to the variability in the assessments of dementia disorders, the self-report measures and the cross-sectional data that are not definitive about directionality of predictors and effects of dementia disorders.

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Section: Effects Of Dementia Disordersmentioning

confidence: 99%

Dementia Disorders: A Narrative Review

Field

2024

J Clin Psychol Neurol

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“…Cancer-induced neuropathic pain, for instance, has distinct pathophysiology, and this issue should be carefully addressed during the collection and analysis of physiological signals [ 98 ]. Moreover, distinct autonomic dysfunctions can be produced by anticancer therapy [ 99 , 100 ], and a bias in the analysis.…”

Section: Research Perspectives and Issuesmentioning

confidence: 99%

Artificial Intelligence for Automatic Pain Assessment: Research Methods and Perspectives

Cascella,

Schiavo,

Cuomo

et al. 2023

Pain Research and Management

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Although proper pain evaluation is mandatory for establishing the appropriate therapy, self-reported pain level assessment has several limitations. Data-driven artificial intelligence (AI) methods can be employed for research on automatic pain assessment (APA). The goal is the development of objective, standardized, and generalizable instruments useful for pain assessment in different clinical contexts. The purpose of this article is to discuss the state of the art of research and perspectives on APA applications in both research and clinical scenarios. Principles of AI functioning will be addressed. For narrative purposes, AI-based methods are grouped into behavioral-based approaches and neurophysiology-based pain detection methods. Since pain is generally accompanied by spontaneous facial behaviors, several approaches for APA are based on image classification and feature extraction. Language features through natural language strategies, body postures, and respiratory-derived elements are other investigated behavioral-based approaches. Neurophysiology-based pain detection is obtained through electroencephalography, electromyography, electrodermal activity, and other biosignals. Recent approaches involve multimode strategies by combining behaviors with neurophysiological findings. Concerning methods, early studies were conducted by machine learning algorithms such as support vector machine, decision tree, and random forest classifiers. More recently, artificial neural networks such as convolutional and recurrent neural network algorithms are implemented, even in combination. Collaboration programs involving clinicians and computer scientists must be aimed at structuring and processing robust datasets that can be used in various settings, from acute to different chronic pain conditions. Finally, it is crucial to apply the concepts of explainability and ethics when examining AI applications for pain research and management.

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“…Detecting pain and delirium in hospitalized persons living with dementia brings many challenges. Barriers at the patient, nurse, environmental, and policy level are present in identifying pain during hospital dementia care ( Liao et al, 2023 ). Although self-report is the gold standard of pain assessment, communication declines seen in individuals with cognitive impairment often necessitate other methods of pain assessment.…”

mentioning

confidence: 99%

The Relationship Between Rejection of Care Behaviors and Pain and Delirium Severity in Hospital Dementia Care

Shaw

Ward

Williams

et al. 2023

Innovation in Aging

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Background and Objectives Rejection of care is common in hospitalized persons living with dementia. However, distinguishing between rejection of care behaviors related to care practices or other causes such as pain or delirium is challenging. The purpose of this study is to further understand the relationship between rejection of care and pain and delirium in hospitalized patients with dementia by identifying which rejection of care behaviors are associated with pain and delirium. Research Design and Methods Care encounters between hospitalized patients with dementia (n=16) and nursing staff (n=53) were observed on 88 separate occasions across 35 days. Rejection of care was measured using the 13 behaviors from the Resistiveness to Care Scale. Pain and delirium severity were measured using a variety of scales including the Pain Assessment in Advanced Dementia Scale (PAINAD), Checklist of Nonverbal Pain Indicators (CNPI), and numeric rating scale for pain severity and the Confusion Assessment Method—Severity (CAM-S) short form and Delirium Observation Screening Scale (DOS) for delirium severity. Linear-mixed-modeling was used to determine the relationship between rejection of care behaviors and pain and delirium severity for each measure. Results 48.9% of the observations included rejection of care, 49.9% included a patient in pain, and 12.5% included a patient with delirium. Cry, push away, scream/yell, and turn away indicated a higher pain severity across pain measures. No rejection of care behaviors were found to indicate delirium severity. Discussion and Implications Certain rejection of care behaviors may be helpful in identifying pain in hospitalized patients with dementia suggesting that caregivers should be cognizant of pain when these rejection of care behaviors are present. However, in this sample rejection of care behaviors were not found to be a useful for identifying delirium severity in hospital dementia care.

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A Systematic Review of Barriers and Facilitators of Pain Management in Persons with Dementia

Cited by 8 publications

References 50 publications

Dementia Disorders: A Narrative Review

Dementia Disorders: A Narrative Review

Artificial Intelligence for Automatic Pain Assessment: Research Methods and Perspectives

The Relationship Between Rejection of Care Behaviors and Pain and Delirium Severity in Hospital Dementia Care

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