Pain assessment and pain treatment for community‐dwelling people with dementia: A systematic review and narrative synthesis

Abstract

Objectives:To describe the current literature on pain assessment and pain treatment for community-dwelling people with dementia. Method:A comprehensive systematic search of the literature with narrative synthesis was conducted. Eight major bibliographic databases were searched in October 2018. Titles, abstracts, and full-text articles were sequentially screened. Standardised data extraction and quality appraisal exercises were conducted. Results:Thirty-two studies were included in the review, 11 reporting findings on pain assessment tools or methods and 27 reporting findings on treatments for pain.In regard to pain assessment, a large proportion of people with moderate to severe dementia were unable to complete a self-report pain instrument. Pain was more commonly reported by informal caregivers than the person with dementia themselves.Limited evidence was available for pain-focused behavioural observation assessment.In regard to pain treatment, paracetamol use was more common in communitydwelling people with dementia compared with people without dementia. However, non-steroidal anti-inflammatory drugs (NSAIDs) were used less. For stronger analgesics, community-dwelling people with dementia were more likely to receive strong opioids (eg, fentanyl) than people without dementia. Conclusion:This review identifies a dearth of high-quality studies exploring pain assessment and/or treatment for community-dwelling people with dementia, not least into non-pharmacological interventions. The consequences of this lack of evidence, given the current and projected prevalence of the disease, are very serious and require urgent redress. In the meantime, clinicians should adopt a patient-and caregiver-centred, multi-dimensional, longitudinal approach to pain assessment and pain treatment for this population.

Pain in Dementia: Prevalence and Association With Neuropsychiatric Behaviors

“…Several studies have investigated the important association between pain and BPSD in community (10) and RACH settings, (8,(25)(26)(27) however limited research is available concerning pain in people with more severe forms of BPSD i.e. those who require specialist behaviour support, using valid instruments.…”

Correlation between biomarkers of pain in saliva and PAINAD scale in elderly people with cognitive impairment and inability to communicate: descriptive study protocol

“…As an alternative to verbal evaluation (or self-report), a significant number of observational scales have been developed in the last 15 years. Several literature review studies describe more than 24 tools of this type14–21 and although none of the tools can be recommended based on existing evidence, several studies advocate the inclusion of any of them within a comprehensive pain care protocol 1 10 22–25…”

The Landscape of Chronic Pain: Broader Perspectives

“…This can be challenging for individuals with limited verbal expression such as infants or with compromised cognitive ability such as individuals with dementia. A recent systematic review of pain management for community-dwelling people with dementia found that informal caregivers were more likely to report pain on behalf of the person with dementia and pain-focused behavioral observation assessment was infrequently used by practitioners [13]. Multimodal assessment of pain that includes self-reported and non-self-reported measures have been developed to capture the complexity of pain experience [14], although it is important to note that behavioral signs, effort testing, self-reported questionnaires, or symptom validity tests have been shown to be unable to identify malingering [15].…”