Chronic pain conditions and use of analgesics among nursing home patients with dementia

Abstract

Pain management for patients with dementia is challenging because many experience pain while being unable to communicate their pain. The aim of this study was to describe pain, pain management, and to perform a thorough clinical examination of chronic pain conditions among patients with dementia. Residents (n 5 498) from 12 nursing homes were assessed for dementia (Clinical Dementia Rating scale [CDR]) and for pain with the Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) assessment form. Of all examined nursing home patients with dementia, 68% had moderate or severe chronic pain. The final study population (n 5 262) with a CDR score of $1 and a MOBID-2 score of $3 were examined by pain expert physicians for chronic pain and categorized according to the International Classification of Disease (ICD-10/-11) classification systems. More than half (54.6%) had chronic pain conditions without underlying disease classified as chronic primary pain by ICD-11. Chronic widespread pain was the most prevalent (14.5%) followed by nonspecific pain from the back (13.4%), whereas the most prevalent chronic secondary pain conditions were chronic pain caused by osteoarthritis (15.4%) and stroke (8.0%). One-fourth received opioids, which was significantly associated with severe pain (P , 0.001) compared with moderate pain, although no significant association was found between opioid use and the type of pain condition. Although knowledge of the severity and specific types of pain conditions is recommended to direct the choice of treatment, these areas are not sufficiently explored in the nursing home populations with dementia and may hinder a better treatment of pain in this population.

The effect of a music-based caregiving intervention on pain intensity in nursing home patients with dementia. A cluster-randomized controlled study

“…In the same population as in the present study, we found that more than half of these patients' most bothersome chronic pain syndromes were because of unknown cause, in ICD-11 named as chronic primary pain. 22 Our hypothesis that a music intervention had a better effect on patients with chronic primary pain was not supported by our data. We found no significant difference when comparing patients with chronic primary pain and those with chronic secondary pain syndromes.…”

“…The current article is limited in that we were not able to track medication changes during the intervention period; however, the analgesic use in this population at baseline is presented elsewhere. 22 Although we coordinated with the nursing homes to reduce the risk for contamination where health personnel would not substitute between intervention and control wards, we could not control to which degree this happened during the intervention period either because of acute needs at the wards, absence or short-term sick leave among staff, or simply whether meals among staff were had in a shared space or similar. A strength was the randomized controlled trial design, the large sample size, and the exact inclusion of patients having both dementia and chronic pain.…”

“…A complete list of the ICD diagnoses and pain syndromes from the population in this study is published elsewhere. 22 This initial clinical examination included a review of each patient's prescribed analgesics and, if needed, optimization was performed in cooperation with the nursing home physician. Analgesic use in both groups was recorded before and after the intervention.…”

“…The overall use before the intervention is presented in a previous article. 22 The nursing homes themselves were completely responsible for every part of the patients' medical treatment, and any second opinion with proposed change in drug treatment was seldom necessary.…”

“…Many older adults living in nursing homes have dementia, 5,8 and over half suffer from pain. 20,22 Deterioration in cognitive functions results in a reduced ability to self-report pain. For chronic pain conditions, long-term medication with analgesic drugs is often not recommended 3 because of severe side effects having particularly serious consequences for the elderly and those with dementia.…”