Policy Implications for Pain in Advanced Alzheimer's Disease

Abstract

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.

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

“…Our psychophysical findings suggest that people with AD could be undertreated for pain, and thus, have a greater risk of suffering from pain compared to cognitively intact older adults. Given communication difficulties sometimes associated with AD ( 51 , 54 ), clinicians and caregivers should be mindful that people with AD likely feel pain but may have difficulty initiating communication of their pain or accurately conveying their pain ( 87 , 99 , 100 ).…”

Pain management for people with dementia: a cross-setting systematic review and meta-ethnography

“…23,25,29,30,45,50,53,54 This consisted of the views of 145 people with dementia, collected through focus groups in two studies 29,50 and interviews in six studies. 23,25,30,45,53,54 Six studies provided basic characteristics data on their cohort with dementia. 25,29,30,45,53,54 This is summarised in Table 1.…”

Feasibility study protocol of the PainChek app to assess the efficacy of a social robot intervention for people with dementia

“…Pharmacological treatment remains as the first-line treatment for underlying causes of pain in older adults; however, people with dementia are more susceptible to the potentially harmful side effects of polypharmacy (Achterberg et al, 2020). Moreover, the absence of effective and safe pharmacological treatment guidelines for chronic pain management in dementia care warrants closer investigation into alternative psychosocial approaches (Anderson et al, 2021;Pu et al, 2019).…”