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Schmerzerfassung bei Demenz

Pain assessment in patients with dementia

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Zusammenfassung

Rezente Studien zeigen, dass gerade demente Patienten häufig eine insuffiziente Schmerztherapie erhalten. Als Grund dafür kann zum Teil sicherlich eine geringe Aufklärung des betreuenden Personals über den Einsatz und die Möglichkeiten der Schmerzerfassung bei dementen Patienten postuliert werden.

Selbstbeurteilungsskalen stellen die valideste Methode zur Schmerzevaluation dar und sollten wann immer möglich primär angeboten werden. Beobachtungen der Situation, des Verhaltens und von physiologischen Markern können unterstützend genutzt werden, wenn die kognitiven Fähigkeiten eine Selbstbeurteilung nicht mehr zulassen. Fremdbeurteilungsskalen erleichtern Dokumentation und Verlaufskontrolle.

Summary

Recent literature demonstrates that pain in patients with dementia is often undertreated. This can partially be explained by a lack of training in the possibilities of assessing pain in patients with dementia.

Subjective reports are the most valid approach for the assessment of the subjective experience of pain and should therefore be preferred over other methods. The assessment of the context, behavior, and physiological markers is advised if the patient is unable to provide a subjective report. Pain assessment scales are useful for documentation and monitoring.

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Literatur

  1. Ags Panel on Persistent Pain in Older Persons (2002) The management of persistent pain in older persons. J Am Geriatr Soc 50:205–224

    Article  Google Scholar 

  2. Basler HD, Huger D, Kunz R et al (2006) Assessment of pain in advanced dementia. Construct validity of the German PAINAD. Schmerz 20:519–526

    Article  PubMed  CAS  Google Scholar 

  3. Cohen-Mansfield J (2008) The relationship between different pain assessments in dementia. Alzheimer Dis Assoc Disord 22:86–93

    Article  PubMed  Google Scholar 

  4. Denecke H, Hunseler C (2000) Assessment and measurement of pain. Schmerz 14:302–308

    Article  PubMed  CAS  Google Scholar 

  5. Desbiens NA, Mueller-Rizner N (2000) How well do surrogates assess the pain of seriously ill patients? Crit Care Med 28:1347–1352

    Article  PubMed  CAS  Google Scholar 

  6. Ferrell BA, Ferrell BR, Rivera L (1995) Pain in cognitively impaired nursing home patients. J Pain Symptom Manage 10:591–598

    Article  PubMed  CAS  Google Scholar 

  7. Ferrell BR, Novy D, Sullivan MD et al (2001) Ethical dilemmas in pain management. J Pain 2:171–180

    Article  PubMed  CAS  Google Scholar 

  8. Ferri CP, Prince M, Brayne C et al (2006) Global prevalence of dementia: a Delphi consensus study. Lancet 366:2112–2117

    Article  Google Scholar 

  9. Fischer T (2009) Entwicklung eines Instruments zum Assessment von Schmerzen bei alten Menschen mit schwerer Demenz. In: Medizinische Fakultät Charité – Universitätsmedizin Berlin. Freie Univerisät Berlin, Berlin, S 192

  10. Fisher SE, Burgio LD, Thorn BE et al (2002) Pain assessment and management in cognitively impaired nursing home residents: association of certified nursing assistant pain report, Minimum Data Set pain report, and analgesic medication use. J Am Geriatr Soc 50:152–156

    Article  PubMed  Google Scholar 

  11. Fuchs-Lacelle S, Hadjistavropoulos T (2004) Development and preliminary validation of the pain assessment checklist for seniors with limited ability to communicate (PACSLAC). Pain Manag Nurs 5:37–49

    Article  PubMed  Google Scholar 

  12. Galicia-Castillo MC, Mcelhaney J (2003) Persistent pain in the elderly. Compr Ther 29:43–46

    Article  PubMed  Google Scholar 

  13. Gnass I, Sirsch E (2009) Schmerzassessment bei Menschen mit Bewusstseinsbeeinträchtigungen In: Bartholomeyczik S, Halek M (Hrsg) Assessmentinstrumente in der Pflege: Möglichkeiten und Grenzen. Schlüter, Hannover, S 173–184

  14. Handel E, Gnass I (2010) Praxishandbuch ZOPA: Schmerzeinschätzung bei Patienten mit kognitiven und/oder Bewusstseinsbeeinträchtigungen. Huber, Bern

  15. Helme RD, Gibson SJ (2001) The epidemiology of pain in elderly people. Clin Geriatr Med 17:417–431

    Article  PubMed  CAS  Google Scholar 

  16. Herr K, Coyne P, Key T et al (2006) Pain assessment in the nonverbal patient: position statement with clinical practice recommendations. Pain Manag Nurs 7:44–52

    Article  PubMed  Google Scholar 

  17. Horgas AL (2003) Pain management in elderly adults. J Infus Nurs 26:161–165

    Article  PubMed  Google Scholar 

  18. Kamel HK, Phlavan M, Malekgoudarzi B et al (2001) Utilizing pain assessment scales increases the frequency of diagnosing pain among elderly nursing home residents. J Pain Symptom Manage 21:450–455

    Article  PubMed  CAS  Google Scholar 

  19. Kunz M, Lautenbacher S (2004) The impact of Alzheimer’s disease on the pain processing. Fortschr Neurol Psychiatr 72:375–382

    Article  PubMed  CAS  Google Scholar 

  20. Kunz M, Lautenbacher S (2005) Veränderung des Schmerzerlebens bei Alzheimer-Patienten. Z Neuropsychol 16:201–209

    Article  Google Scholar 

  21. Kunz M, Scharmann S, Hemmeter U et al (2007) The facial expression of pain in patients with dementia. Pain 133:221–228

    Article  PubMed  Google Scholar 

  22. Lautenbacher S, Kunz M, Strate P et al (2005) Age effects on pain thresholds, temporal summation and spatial summation of heat and pressure pain. Pain 115:410–418

    Article  PubMed  Google Scholar 

  23. Lints-Martindale AC, Hadjistavropoulos T, Barber B et al (2007) A psychophysical investigation of the facial action coding system as an index of pain variability among older adults with and without Alzheimer’s disease. Pain Med 8:678–689

    Article  PubMed  Google Scholar 

  24. Maier W, Jessen F (2010) Evidence-based standards for care of patients with dementia. The interdisciplinary S 3 guideline for dementia. Nervenarzt 81:795

    Article  PubMed  CAS  Google Scholar 

  25. Matthews FE, Dening T (2002) Prevalence of dementia in institutional care. Lancet 360:225–226

    Article  PubMed  Google Scholar 

  26. Mccaffery M, Pasero C (1999) Pain: clinical manual. Mosby, St. Louis

  27. Mitchell C (2001) Assessment and management of chronic pain in elderly people. Br J Nurs 10:296–304

    PubMed  CAS  Google Scholar 

  28. Pergolizzi J, Boger RH, Budd K et al (2008) Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract 8:287–313

    Article  PubMed  Google Scholar 

  29. Pinter G, Likar R, Anditsch M et al (2010) Problems of pain measurement and pain therapy in the elderly. Wien Med Wochenschr 160:235–246

    Article  PubMed  Google Scholar 

  30. Rainero I, Vighetti S, Bergamasco B et al (2000) Autonomic responses and pain perception in Alzheimer’s disease. Eur J Pain 4:267–274

    Article  PubMed  CAS  Google Scholar 

  31. Rodriguez CS (2001) Pain measurement in the elderly: a review. Pain Manag Nurs 2:38–46

    Article  PubMed  CAS  Google Scholar 

  32. Ruoff GE (2002) Challenges of managing chronic pain in the elderly. Semin Arthritis Rheum 32:43–50

    Article  PubMed  CAS  Google Scholar 

  33. Scherder EJ, Bouma A (1997) Is decreased use of analgesics in Alzheimer disease due to a change in the affective component of pain? Alzheimer Dis Assoc Disord 11:171–174

    Article  PubMed  CAS  Google Scholar 

  34. Scherder EJA, Sergeant JA, Swaab DF (2003) Pain processing in dementia and its relation to neuropathology. Lancet Neurol 2:677–686

    Article  PubMed  Google Scholar 

  35. Schuler M, Neuhauser T, Hauer K et al (2001) Recognizing pain in geriatric patients by an interdisciplinary team. Reliability of judgment and factors of influence. Z Gerontol Geriatr 34:376–386

    Article  PubMed  CAS  Google Scholar 

  36. Schuler MS, Becker S, Kaspar R et al (2007) Psychometric properties of the German „Pain Assessment in Advanced Dementia Scale“ (PAINAD-G) in nursing home residents. J Am Med Dir Assoc 8:388–395

    Article  PubMed  Google Scholar 

  37. Schwermann M, Münch M (2008) Professionelles Schmerzassessment bei Menschen mit Demenz: ein Leitfaden für die Pflegepraxis. Kohlhammer, Stuttgart

  38. Shega JW, Hougham GW, Stocking CB et al (2006) Management of noncancer pain in community-dwelling persons with dementia. J Am Geriatr Soc 54:1892–1897

    Article  PubMed  Google Scholar 

  39. Shega JW, Hougham GW, Stocking CB et al (2004) Pain in community-dwelling persons with dementia: frequency, intensity, and congruence between patient and caregiver report. J Pain Symptom Manage 28:585–592

    Article  PubMed  Google Scholar 

  40. Snow AL, O’malley K J, Cody M et al (2004) A conceptual model of pain assessment for noncommunicative persons with dementia. Gerontologist 44:807–817

    Article  PubMed  Google Scholar 

  41. Stewart M, Verkerk GA, Stafford KJ et al (2010) Noninvasive assessment of autonomic activity for evaluation of pain in calves, using surgical castration as a model. J Dairy Sci 93:3602–3609

    Article  PubMed  CAS  Google Scholar 

  42. Warden V, Hurley AC, Volicer L (2003) Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc 4:9–15

    Article  PubMed  Google Scholar 

  43. Werner P, Cohen-Mansfield J, Watson V et al (1998) Pain in participants of adult day care centers: assessment by different raters. J Pain Symptom Manage 15:8–17

    Article  PubMed  CAS  Google Scholar 

  44. Wilson J, O’donnell M, Mcauliffe L et al (2008) Assessment of pain in older adults with dementia in acute, sub acute and residential care (Systematic review). Australian Centre for Evidence Based Aged Care, La Trobe Univ

  45. Wynne CF, Ling SM, Remsburg R (2000) Comparison of pain assessment instruments in cognitively intact and cognitively impaired nursing home residents. Geriatr Nurs 21:20–23

    Article  PubMed  CAS  Google Scholar 

  46. Zwakhalen SM, Hamers JP, Abu-Saad HH et al (2006) Pain in elderly people with severe dementia: a systematic review of behavioural pain assessment tools. BMC Geriatr 6:3

    Article  PubMed  Google Scholar 

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Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Danksagung

Die Autoren danken Dr. Margot Glatz, Abteilung für Anästhesiologie und Intensivmedizin Landesklinikum St. Pölten, für ihre wertvollen Anmerkungen zum Thema.

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Authors and Affiliations

  1. Universitätsklinik für Anästhesiologie und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 29, 8036, Graz, Österreich

    H. Bornemann-Cimenti, M. Wejbora, K. Michaeli, C. Kern-Pirsch &  A. Sandner-Kiesling

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  1. H. Bornemann-Cimenti
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  2. M. Wejbora
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  3. K. Michaeli
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  4. C. Kern-Pirsch
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  5. A. Sandner-Kiesling
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Correspondence to A. Sandner-Kiesling.

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Bornemann-Cimenti, H., Wejbora, M., Michaeli, K. et al. Schmerzerfassung bei Demenz. Nervenarzt 83, 458–466 (2012). https://doi.org/10.1007/s00115-011-3385-5

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