Pain Assessment in People With Dementia: Remaining Controversies

Rababa, Mohammad

doi:10.5539/gjhs.v10n5p62

Cited by 11 publications

(6 citation statements)

References 34 publications

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“…This work underscores the importance of understanding biological differences in pain processing when evaluating differences in pain reporting in AD. Findings furthermore support the use of multi-dimensional pain assessment practices ( 87 ) and tools ( 88 ) since most clinicians and clinical systems use a simple 0–10 scale assessing only the sensory rather than affective component of pain ( 89 , 90 ). This work suggests alternative assessment strategies to better capture altered pain responses in AD, reducing the potential for poorly managed pain and unnecessary suffering in this population.…”

Section: Discussionsupporting

confidence: 53%

“…Results indicating greater activation in AD participants relative to controls in the PAG for the contrast comparison of warmth greater than prestimulus (left) and mild pain greater than baseline (right). and clinical systems use a simple 0-10 scale assessing only the sensory rather than affective component of pain (89,90). This work suggests alternative assessment strategies to better capture altered pain responses in AD, reducing the potential for poorly managed pain and unnecessary suffering in this population.…”

Section: Discussionmentioning

confidence: 99%

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Increased pain unpleasantness and pain-related fMRI activation in the periaqueductal gray in Alzheimer's disease

Anderson

Monroe²,

Dietrich³

et al. 2022

Front. Pain Res.

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BackgroundPain continues to be underrecognized and undertreated in people with Alzheimer's disease (AD). The periaqueductal gray (PAG) is essential to pain processing and modulation yet is damaged by AD. While evidence exists of altered neural processing of pain in AD, there has not been a focused investigation of the PAG during pain in people with AD.PurposeTo investigate the role of the PAG in sensory and affective pain processing for people living with AD.MethodsParticipants from a larger study completed pain psychophysics assessments and then a perceptually-matched heat pain task (warmth, mild, and moderate pain) during a functional MRI scan. In this cross-sectional study, we examined blood oxygenation level-dependent (BOLD) responses in the PAG and other pain-related regions in participants with AD (n = 18) and cognitively intact older adults (age- and sex-matched, n = 18). Associations of BOLD percent signal change and psychophysics were also examined.ResultsThere were significant main effects of AD status on the temperature needed to reach each perception of warmth or pain, where people with AD reached higher temperatures. Furthermore, participants with AD rated mild and moderate pain as more unpleasant than controls. PAG BOLD activation was greater in AD relative to controls during warmth and mild pain percepts. No significant differences were found for moderate pain or in other regions of interest. Greater PAG activation during mild pain was associated with higher affective/unpleasantness ratings of mild pain in participants with AD but not in controls.ConclusionResults suggest a role for the PAG in altered pain responses in people with AD. The PAG is the primary source of endogenous opioid pain inhibition in the neuroaxis, thus, altered PAG function in AD suggests possible changes in descending pain inhibitory circuits. People with AD may have a greater risk of suffering from pain compared to cognitively intact older adults.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Increased pain unpleasantness and pain-related fMRI activation in the periaqueductal gray in Alzheimer's disease

Anderson

Monroe²,

Dietrich³

et al. 2022

Front. Pain Res.

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“…The PAINAD scale is a tool of acknowledged utility for the assessment of pain in people with cognitive impairment and communication inability 46…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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IntroductionPain is an under-diagnosed problem in elderly people, especially in those with cognitive impairment who are unable to verbalise their pain. Although the Pain assessment in advanced dementia scale (PAINAD) scale is a tool recognised for its clinical interest in this type of patients, its correlation with the saliva biomarkers reinforced its utility. The aim of this research will be to correlate the scores of this scale with the levels of biomarkers of pain found in saliva samples of patients with cognitive impairment and inability to communicate.Methods and analysisThis is an observational study. The level of pain will be evaluated using the PAINAD scale. Moreover, pain biomarkers, in particular secretory IgA and soluble tumour necrosis factor receptor type II, will be determined in saliva. Both assessments will be conducted in 75 patients aged over 65 years with advanced cognitive impairment and inability to communicate. The PAINAD scores will be correlated with the levels of these biomarkers of pain. A control group consisting of 75 healthy subjects aged over 65 years will be included in the study. Moreover, sociodemographic variables and variables related to pain, dementia and other clinical conditions will be recorded. The analysis will be performed with the statistical package SPSS V.22 and the software R.Ethics and disseminationThe study has been reviewed and approved by the Andalusian Human Research Ethics Committee. In addition, this study has been financed by the Junta de Andalucía through a regional health research fund (Research code: PI-0357–2017). The results will be actively disseminated trough a high-impact journal in our study area, conference presentations and social media.

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“…These definitions appear to be built on the assumption that individuals experiencing pain have the capacity at some level to communicate their pain. This is not always the case, as self-report is often ineffective for noncommunicative individuals and those unable to understand a pain scale because of memory loss or cognitive impairment (Cravello et al, 2019;Hadjistavropoulos et al, 2014;Monroe & Mion, 2012;Rababa, 2018b). The ASPMN acknowledges this issue, as demonstrated in one of their recent position statements (Herr et al, 2019).…”

Section: Pain Assessment and Management In Alzheimer Diseasementioning

confidence: 99%

“…If a pain behavior is absent, such as in the presence of pathological disorders or adverse drug effects (Monroe et al, 2012a;Paulson et al, 2014), or unnoticed (Cohen-Mansfield & Creedon, 2002) at the time of observation, observational scales may be ineffective (Monroe & Mion, 2012). Despite multiple studies, there is still controversy about which behaviors truly indicate pain rather than another unmet need (Rababa, 2018a(Rababa, , 2018b, although recent studies may improve our understanding (Kunz et al, 2020b). Additionally, behavioral changes can be misunderstood or misinterpreted by nursing staff (McAuliffe et al, 2009;Rababa, 2018a), and beliefs and expectations held by nurses affect the interpretation of pain behaviors (Rantala, 2014).…”

Section: Pain Assessment and Management In Alzheimer Diseasementioning

confidence: 99%

Policy Implications for Pain in Advanced Alzheimer's Disease

Anderson

Hyden

Failla

et al. 2021

Pain Management Nursing

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Untreated pain in people with Alzheimer's disease continues to be a serious public health problem. Pain is a subjective and complex experience that becomes increasingly challenging to assess as cognition declines. Our understanding of pain processing is incomplete, particularly for special populations such as people living with Alzheimer's disease, and especially in the advanced stages of the disease. Painprocessing networks in the brain are altered in Alzheimer's disease, yet evidence suggests people living with Alzheimer's disease do not experience less pain. Rather, their pain is not adequately recognized or treated. Although scholarly publications provide important assistance, recent widespread reports and guidelines do not include sufficient guidance, especially as Alzheimer's disease progresses to the last stages. Additionally, current pain measurements may not accurately evaluate pain in this condition, and the existing definitions of pain are not adequate when considering the effects of Alzheimer's disease on pain-processing in the brain. There is a need for new, widespread policies, guidelines, and definitions to help clinicians adequately manage pain in people with Alzheimer's disease. These will need to hinge on continued research because it remains unclear how Alzheimer's disease impacts central pain processing, pain expression, and communication of pain. In the meantime, policies and guidelines need to highlight current best practices as well as the fact that pain continues in Alzheimer's disease.

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Pain Assessment in People With Dementia: Remaining Controversies

Cited by 11 publications

References 34 publications

Increased pain unpleasantness and pain-related fMRI activation in the periaqueductal gray in Alzheimer's disease

Increased pain unpleasantness and pain-related fMRI activation in the periaqueductal gray in Alzheimer's disease

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

Policy Implications for Pain in Advanced Alzheimer's Disease

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