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Erschienen in: Zeitschrift für Gerontologie und Geriatrie 1/2012

01.01.2012 | Beiträge zum Themenschwerpunkt

Pain and dementia

A diagnostic challenge

verfasst von: Dr. A. Lukas, M. Schuler, T.W. Fischer, S.J. Gibson, S.M. Savvas, T. Nikolaus, M. Denkinger

Erschienen in: Zeitschrift für Gerontologie und Geriatrie | Ausgabe 1/2012

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Abstract

Purpose

The aim was to present current knowledge about pain assessment in people with dementia and to discuss special challenges and possible solutions.

Methods

A literature search in MEDLINE® was performed.

Results

Due to the changing demographics of an aging population, an increasing number of people with dementia is expected. Many of these people will simultaneously suffer pain. Under-detection and under-treatment of pain in persons suffering from dementia is often described. As dementia progresses, the ability of the sufferer to verbally communicate his/her pain is often compromised, complicating the task of recognizing and treating pain. To improve pain recognition in dementia, many pain assessment tools have been developed. However, psychometric properties have to date been insufficiently examined.

Implications

Self-report ratings should be performed as long as justifiable. Behavioural pain assessment tools should be used in advanced dementia despite their current imperfections: in particular, the PAINAD for daily use and the PACSLAC at longer intervals. All available additional information about pain should be considered.
Literatur
1.
Zurück zum Zitat Achterberg WP, Gambassi G, Finne-Soveri H et al (2010) Pain in European long-term care facilities: cross-national study in Finland, Italy and The Netherlands. Pain 148:70–74 PubMedCrossRef Achterberg WP, Gambassi G, Finne-Soveri H et al (2010) Pain in European long-term care facilities: cross-national study in Finland, Italy and The Netherlands. Pain 148:70–74 PubMedCrossRef
2.
Zurück zum Zitat AGS (2002) The management of persistent pain in older persons. J Am Geriatr Soc 50:205–224 CrossRef AGS (2002) The management of persistent pain in older persons. J Am Geriatr Soc 50:205–224 CrossRef
3.
Zurück zum Zitat AGS (2009) Pharmacological management of persistent pain in older persons. J Am Geriatr Soc 57:1331–1346 CrossRef AGS (2009) Pharmacological management of persistent pain in older persons. J Am Geriatr Soc 57:1331–1346 CrossRef
4.
Zurück zum Zitat Basler HD, Hueger D, Kunz R et al (2006) Assessment of pain in advanced dementia. Construct validity of the German PAINAD. Schmerz 20:519–526 PubMedCrossRef Basler HD, Hueger D, Kunz R et al (2006) Assessment of pain in advanced dementia. Construct validity of the German PAINAD. Schmerz 20:519–526 PubMedCrossRef
5.
Zurück zum Zitat Benedetti F, Vighetti S, Ricco C et al (1999) Pain threshold and tolerance in Alzheimer’s disease. Pain 80:377–382 PubMedCrossRef Benedetti F, Vighetti S, Ricco C et al (1999) Pain threshold and tolerance in Alzheimer’s disease. Pain 80:377–382 PubMedCrossRef
6.
Zurück zum Zitat Bickel H (ed) (1999) Epidemiologie der Demenzen. Springer, Berlin Bickel H (ed) (1999) Epidemiologie der Demenzen. Springer, Berlin
7.
Zurück zum Zitat Brodaty H, Ames D, Snowdon J et al (2005) Risperidone for psychosis of Alzheimer’s disease and mixed dementia: results of a double-blind, placebo-controlled trial. Int J Geriatr Psychiatry 20:1153–1157 PubMedCrossRef Brodaty H, Ames D, Snowdon J et al (2005) Risperidone for psychosis of Alzheimer’s disease and mixed dementia: results of a double-blind, placebo-controlled trial. Int J Geriatr Psychiatry 20:1153–1157 PubMedCrossRef
8.
Zurück zum Zitat Brookmeyer R, Johnson E, Ziegler-Graham K et al (2007) Forecasting the global burden of Alzheimer’s disease. Alzheimers Dement 3:186–191 PubMedCrossRef Brookmeyer R, Johnson E, Ziegler-Graham K et al (2007) Forecasting the global burden of Alzheimer’s disease. Alzheimers Dement 3:186–191 PubMedCrossRef
9.
Zurück zum Zitat Cole LJ, Farrell MJ, Duff EP et al (2006) Pain sensitivity and fMRI pain-related brain activity in Alzheimer’s disease. Brain 129:2957–2965 PubMedCrossRef Cole LJ, Farrell MJ, Duff EP et al (2006) Pain sensitivity and fMRI pain-related brain activity in Alzheimer’s disease. Brain 129:2957–2965 PubMedCrossRef
10.
Zurück zum Zitat Cole LJ, Farrell MJ, Gibson SJ et al (2010) Age-related differences in pain sensitivity and regional brain activity evoked by noxious pressure. Neurobiol Aging 31:494–503 PubMedCrossRef Cole LJ, Farrell MJ, Gibson SJ et al (2010) Age-related differences in pain sensitivity and regional brain activity evoked by noxious pressure. Neurobiol Aging 31:494–503 PubMedCrossRef
11.
Zurück zum Zitat Dewaters T, Faut-Callahan M, Mccann JJ et al (2008) Comparison of self-reported pain and the PAINAD scale in hospitalized cognitively impaired and intact older adults after hip fracture surgery. Orthop Nurs 27:21–28 PubMedCrossRef Dewaters T, Faut-Callahan M, Mccann JJ et al (2008) Comparison of self-reported pain and the PAINAD scale in hospitalized cognitively impaired and intact older adults after hip fracture surgery. Orthop Nurs 27:21–28 PubMedCrossRef
12.
Zurück zum Zitat Fischer T (2009) Schmerzeinschätzung bei Menschen mit schwerer Demenz: Das Beobachtungsinstrument für das Schmerzassessment bei alten Menschen mit schwerer Demenz (BISAD). Hans Huber, Bern Fischer T (2009) Schmerzeinschätzung bei Menschen mit schwerer Demenz: Das Beobachtungsinstrument für das Schmerzassessment bei alten Menschen mit schwerer Demenz (BISAD). Hans Huber, Bern
13.
Zurück zum Zitat Fitzcharles MA, Lussier D, Shir Y (2010) Management of chronic arthritis pain in the elderly. Drugs Aging 27:471–490 PubMedCrossRef Fitzcharles MA, Lussier D, Shir Y (2010) Management of chronic arthritis pain in the elderly. Drugs Aging 27:471–490 PubMedCrossRef
14.
Zurück zum Zitat Gagliese L, Weizblit N, Ellis W et al (2005) The measurement of postoperative pain: a comparison of intensity scales in younger and older surgical patients. Pain 117:412–420 PubMedCrossRef Gagliese L, Weizblit N, Ellis W et al (2005) The measurement of postoperative pain: a comparison of intensity scales in younger and older surgical patients. Pain 117:412–420 PubMedCrossRef
15.
Zurück zum Zitat Gibson SJ (2007) IASP global year against pain in older persons: highlighting the current status and future perspectives in geriatric pain. Expert Rev Neurother 7:627–635 PubMedCrossRef Gibson SJ (2007) IASP global year against pain in older persons: highlighting the current status and future perspectives in geriatric pain. Expert Rev Neurother 7:627–635 PubMedCrossRef
16.
Zurück zum Zitat Hadjistavropoulos TP, Herr KP, Turk DCP et al (2007) An interdisciplinary expert consensus statement on assessment of pain in older persons. Clin J Pain 23(Suppl):1–43 CrossRef Hadjistavropoulos TP, Herr KP, Turk DCP et al (2007) An interdisciplinary expert consensus statement on assessment of pain in older persons. Clin J Pain 23(Suppl):1–43 CrossRef
17.
Zurück zum Zitat Herr K (2011) Pain assessment strategies in older patients. J Pain 12:3–13 CrossRef Herr K (2011) Pain assessment strategies in older patients. J Pain 12:3–13 CrossRef
18.
Zurück zum Zitat Herr K, Bjoro K, Decker S (2006) Tools for assessment of pain in nonverbal older adults with dementia: a state-of-the-science review. J Pain Symptom Manage 31:170–192 PubMedCrossRef Herr K, Bjoro K, Decker S (2006) Tools for assessment of pain in nonverbal older adults with dementia: a state-of-the-science review. J Pain Symptom Manage 31:170–192 PubMedCrossRef
19.
Zurück zum Zitat Herr K, Bursch H, Ersek M et al (2010) Use of pain-behavioral assessment tools in the nursing home: expert consensus recommendations for practice. J Gerontol Nurs 36:18–29, quiz 30–11 PubMedCrossRef Herr K, Bursch H, Ersek M et al (2010) Use of pain-behavioral assessment tools in the nursing home: expert consensus recommendations for practice. J Gerontol Nurs 36:18–29, quiz 30–11 PubMedCrossRef
20.
Zurück zum Zitat Herr KA, Spratt K, Mobily PR et al (2004) Pain intensity assessment in older adults: use of experimental pain to compare psychometric properties and usability of selected pain scales with younger adults. Clin J Pain 20:207–219 PubMedCrossRef Herr KA, Spratt K, Mobily PR et al (2004) Pain intensity assessment in older adults: use of experimental pain to compare psychometric properties and usability of selected pain scales with younger adults. Clin J Pain 20:207–219 PubMedCrossRef
21.
Zurück zum Zitat Husebo BS, Ballard C, Sandvik R et al (2011) Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial. BMJ 343:d4065 PubMedCrossRef Husebo BS, Ballard C, Sandvik R et al (2011) Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial. BMJ 343:d4065 PubMedCrossRef
22.
Zurück zum Zitat Kovach CR, Logan BR, Noonan PE et al (2006) Effects of the Serial Trial Intervention on discomfort and behavior of nursing home residents with dementia. Am J Alzheimers Dis Other Demen 21:147–155 PubMedCrossRef Kovach CR, Logan BR, Noonan PE et al (2006) Effects of the Serial Trial Intervention on discomfort and behavior of nursing home residents with dementia. Am J Alzheimers Dis Other Demen 21:147–155 PubMedCrossRef
23.
Zurück zum Zitat Kunz M, Mylius V, Scharmann S et al (2009) Influence of dementia on multiple components of pain. Eur J Pain 13:317–325 PubMedCrossRef Kunz M, Mylius V, Scharmann S et al (2009) Influence of dementia on multiple components of pain. Eur J Pain 13:317–325 PubMedCrossRef
24.
Zurück zum Zitat Lautenschlager NT, Cox KL, Flicker L et al (2008) Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA 300:1027–1037 PubMedCrossRef Lautenschlager NT, Cox KL, Flicker L et al (2008) Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA 300:1027–1037 PubMedCrossRef
25.
Zurück zum Zitat Mattenklodt P, Ingenhorst A, Wille C et al (2008) Multimodal group therapy for the elderly with chronic pain: concept and results in a before and after comparison. Schmerz 22:551–554, 556–561 PubMedCrossRef Mattenklodt P, Ingenhorst A, Wille C et al (2008) Multimodal group therapy for the elderly with chronic pain: concept and results in a before and after comparison. Schmerz 22:551–554, 556–561 PubMedCrossRef
26.
Zurück zum Zitat Maxwell C, Dalby D, Slater M et al (2008) The prevalence and management of current daily pain among older home care clients. Pain 138:208–216 PubMedCrossRef Maxwell C, Dalby D, Slater M et al (2008) The prevalence and management of current daily pain among older home care clients. Pain 138:208–216 PubMedCrossRef
27.
Zurück zum Zitat Morrison RS, Siu AL (2000) A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fracture. J Pain Symptom Manage 19:240–248 PubMedCrossRef Morrison RS, Siu AL (2000) A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fracture. J Pain Symptom Manage 19:240–248 PubMedCrossRef
28.
Zurück zum Zitat Pickering G, Jourdan D, Dubray C (2006) Acute versus chronic pain treatment in Alzheimer’s disease. Eur J Pain 10:379–384 PubMedCrossRef Pickering G, Jourdan D, Dubray C (2006) Acute versus chronic pain treatment in Alzheimer’s disease. Eur J Pain 10:379–384 PubMedCrossRef
29.
30.
Zurück zum Zitat Scherder E, Oosterman J, Swaab D et al (2005) Recent developments in pain in dementia. BMJ 330:461–464 PubMedCrossRef Scherder E, Oosterman J, Swaab D et al (2005) Recent developments in pain in dementia. BMJ 330:461–464 PubMedCrossRef
31.
Zurück zum Zitat 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 PubMedCrossRef 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 PubMedCrossRef
32.
Zurück zum Zitat 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 PubMedCrossRef 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 PubMedCrossRef
33.
Zurück zum Zitat Snow AL, O’malley KJ, Cody M et al (2004) A conceptual model of pain assessment for noncommunicative persons with dementia. Gerontologist 44:807–817 PubMedCrossRef Snow AL, O’malley KJ, Cody M et al (2004) A conceptual model of pain assessment for noncommunicative persons with dementia. Gerontologist 44:807–817 PubMedCrossRef
34.
Zurück zum Zitat Tosato M, Lukas A, Danese P et al (2011) Association of pain with behavioral and psychiatric symptoms among nursing home residents with cognitive impairment: results from the SHELTER study. Pain. [Epub ahead of print 16 Nov] Tosato M, Lukas A, Danese P et al (2011) Association of pain with behavioral and psychiatric symptoms among nursing home residents with cognitive impairment: results from the SHELTER study. Pain. [Epub ahead of print 16 Nov]
35.
Zurück zum Zitat Weiner DK, Hanlon JT (2001) Pain in nursing home residents: management strategies. Drugs Aging 18:13–29 PubMedCrossRef Weiner DK, Hanlon JT (2001) Pain in nursing home residents: management strategies. Drugs Aging 18:13–29 PubMedCrossRef
36.
Zurück zum Zitat Zwakhalen S, Hamers J, Abu-Saad H et al (2006) Pain in elderly people with severe dementia: a systematic review of behavioural pain assessment tools. BMC Geriatr 6. doi:10.1186/1471-2318-6-3 Zwakhalen S, Hamers J, Abu-Saad H et al (2006) Pain in elderly people with severe dementia: a systematic review of behavioural pain assessment tools. BMC Geriatr 6. doi:10.1186/1471-2318-6-3
Metadaten
Titel
Pain and dementia
A diagnostic challenge
verfasst von
Dr. A. Lukas
M. Schuler
T.W. Fischer
S.J. Gibson
S.M. Savvas
T. Nikolaus
M. Denkinger
Publikationsdatum
01.01.2012
Verlag
Springer-Verlag
Erschienen in
Zeitschrift für Gerontologie und Geriatrie / Ausgabe 1/2012
Print ISSN: 0948-6704
Elektronische ISSN: 1435-1269
DOI
https://doi.org/10.1007/s00391-011-0272-4

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