Efficacy of non‐pharmacological interventions to reduce pain in people with dementia: A systematic review and meta‐analysis

Abstract

Aims and objectives: To identify the efficacy of non-pharmacological interventions designed to reduce pain in people with dementia. Background: Pain is prevalent among patients with dementia but frequently remains untreated. Although non-pharmacological interventions have been used to reduce pain in people with dementia, the efficacy of these interventions for pain management in people with dementia has not been thoroughly synthesised. Design: Systematic review and meta-analysis. Methods: The study was conducted in accordance with PRISMA guidelines and Cochrane criteria for systematic reviews. A comprehensive search was performed using the Academic Search Complete, CINAHL, Cochrane Library, EMBASE, MEDLINE, PubMed, OVID and Web of Science databases, from databases inception to 13 March 2022. The modified Cochrane risk-of-bias tool (ROB-2) was used to evaluate the methodological quality of each included study. Standardised mean differences (SMDs) with 95% confidence intervals (CIs) were synthesised using a random-effects model to assess the efficacy of non-pharmacological interventions for reducing pain in people with dementia (using Stata 16.0). Results: The final analysis assessed 12 studies, including 989 persons with dementia. Non-pharmacological interventions were found to reduce pain in 4-8 weeks after the interventions (SMD: −0.32; 95% CI: −0.62 to −0.02). However, the effects of intervention frequency and patient age remain unknown. Conclusions: Non-pharmacological interventions are effective for reducing pain in people with dementia. Further investigations remain necessary to explore the effectiveness of specific non-pharmacological therapies for pain reduction in people with dementia (e.g. aromatherapy, play activity, singing or robotic care). Relevance to clinical practice:The findings of this study can guide healthcare practitioners when considering the use of non-pharmacological pain management methods for people with dementia and may improve the implementation of these methods in clinical practice. Patient or public contributions:The study suggests non-pharmacological interventions to reduce pain and underlines the relevance of health provider's viewpoints. The | 5287 SARAGIH et Al. Stages of dementia Experimental group Control group NA Massage Received 'namaste care' to comfort and pleasure people with advanced dementia through engagement, meaningful and creative Received palliative care Every day for 2 h NA Baseline and at 2 weeks, 4 weeks and 24 weeks PAINAD NA Resistance exercise Received muscle resistance training, range of motion, and stretching Received no intervention 3 times a week for 2 h 4 weeks Baseline and at 2 weeks, 4 weeks PACSLAC-D Mild-to-moderate dementia Massage Received progressive relaxation by reflexology followed by light stretching of the foot or hand Received friendly visit Once a week for 30 min 4 weeks Baseline and 8 weeks CNPI NA Massage Received massage Routine pain treatments 4 times a week for 40 min 4 weeks Baseline and 4 weeks PAINAD Mild-to-moderate dementia Exercise

Comment on ‘Efficacy of non‐pharmacological interventions to reduce pain in people with dementia: A systematic review and meta‐analysis’

“…For example, in the study by Pongan et al (Pongan et al, 2017), the original authors only stated randomization but not introduced the method. However, Saragih et al (Saragih et al, 2023) inappropriately set the randomization process as low risk (Table 1). Third, except for the differences in the intervention group between studies, there were corresponding differences in the control group between studies.…”