Pain management in elderly with dementia
There are an estimated 35 million people with dementia across the world, of whom 50% experience regular pain. Despite this, current assessment and treatment of pain in this patient group are inadequate.
Pain Control in the Elderly and Individuals with Dementia
The goal of this guideline is to provide information on how best to manage chronic non-cancer pain in older adults and individuals with dementia. This document was developed by an interdisciplinary group of experts from across the state who reviewed current evidence regarding CNCP treatment options for these populations. It provides recommendations based upon available scientific literature as well as expert opinion.
Chronic Pain in the Elderly Population
In general, older adults have an increased incidence of both acute and chronic pain compared to younger individuals. The prevalence of chronic pain increases as age advances; it has been estimated that approximately 50% of people over 65 years old experience some form of chronic pain.
Evaluation of the Elderly Patient
A thorough history should include questions about:
- The presence or absence of any underlying disease that could cause persistent pain
- Any previous episodes of acute pain
- Current medications used by the patient
- Previous treatments received for this problem
- How long has the current condition been going on? Has it changed over time? Is there an associated symptom?
- What makes you think your symptoms are related to something else?
Goals of Treatment
Reduce pain intensity and frequency.
Decrease analgesic use.
Enhance functional status.
Improve sleep patterns.
Nonsteroidal anti-inflammatory drugs, acetaminophen, opioids, muscle relaxants, antidepressants, anticonvulsant agents, topical anesthetics, local nerve blocks, and regional anesthesia techniques are used alone or in combination depending upon the severity of the condition
A variety of pharmacological agents has been used successfully to manage persistent pain.36 These include NSAIDs, opioids, anticonvulsants, antidepressants, muscle relaxers, topical analgesics, local anesthetics, corticosteroids, antiemetics, antipsychotics, anxiolytics, hypnotics/sedatives, and others.
Opioids: Short-acting opioids are preferred over long-acting agents due to increased risks associated with prolonged use.
Tramadol has been shown to reduce opioid requirements by 50%,37 which makes it an attractive option for those who cannot tolerate higher doses of narcotics.38 Tramadol also reduces nausea and vomiting
Antidepressants: Antidepressant drugs are often used to manage neuropathic pain syndromes.
Pain Treatment in Patients with Dementia
Because chronic, non-cancer pain is more likely to be reduced than eliminated, ongoing pain reporting is common.
In those with advanced dementia who may be unable to communicate verbally about their pain, you may need to evaluate their condition (and their response to treatment) by facial expressions, verbalizations, body movements, changes in interpersonal interactions, activity patterns and routines such as sleep disruption and appetite suppression. Multiple questionnaires have been developed with variable success rates in eliciting pain levels in persons with dementia, with no general consensus on which one is superior.38
Patients may also exhibit striking out, refusing medications, agitation, delirium, increased restlessness, and social withdrawal. Rule out other potential infectious, metabolic, medication-related, and social-situation changes as possible causes for acute decline.
Prescribe a trial of scheduled medications (be cautious with scheduled NSAIDs). Use a stepwise approach.
Start low, go slow, be aware of possible under treatment.
Monitor the patient carefully to balance the risks and benefits of the treatment.
Be alert to herbal and dietary supplements taken by older patients who may not volunteer this information. They may be prone to drug-supplement interactions.
Patients who don’t respond to one medication may respond to another.
Did you Know?
Factual sentences referenced across top search results:
- There are an estimated 35 million people with dementia across the world, of whom 50% experience regular pain. (ncbi.nlm.nih.gov)
- There are an estimated 35 million people with dementia across the world. (ncbi.nlm.nih.gov)
- Currently, 5% of people over 65 years old have a diagnosis of dementia, rising to over 50% in those aged over 90 years. (ncbi.nlm.nih.gov)
- The prevalence of pain, particularly chronic pain, is strongly related to age, hitting the oldest population the hardest, with prevalence rates of 72% above the age of 85 years. (ncbi.nlm.nih.gov)
- Evidence indicates that around 60%–80% of people with dementia in care homes regularly experience pain, most commonly related to musculoskeletal, gastrointestinal and cardiac conditions; genitourinary infections; and pressure ulcers. (ncbi.nlm.nih.gov)
- the verbal-, visual-, and faces pain scales), found that 61% understood at least one scale; that is, they were able to explain the scale use and correctly indicate positions for no pain and extreme pain on two separate occasions. (ncbi.nlm.nih.gov)
- Approximately 35% of stroke patients suffer from post-stroke central neuropathic pain. (ncbi.nlm.nih.gov)
- Taken together, the literature indicates that about 50% of patients with dementia are regularly in pain. (ncbi.nlm.nih.gov)
- Persistent pain (three to six months) is present in 25–50% of older adults and increases with age. (oregonpainguidance.org)
- Nursing home patients may have prevalence as high as 45–80%.33 (oregonpainguidance.org)
Questions used across top search results:
How do you manage pain from dementia?
One of the most common and effective medicines to relieve pain in advanced dementia is paracetamol. Ensure medication is given as prescribed. This can be when it is needed – if the pain is constant give it regularly.
Why is pain management important in dementia?
Causes of pain and ways to alleviate it
Investigating why the person with dementia is in pain is doubly important: to help them be more comfortable, but also to avoid the unnecessary prescription of treatments for their restlessness or agitation.
What is the best pain medication for the elderly?
Acetaminophen: American Geriatrics Society (AGS) recommends acetaminophen as the first-line agent for mild to moderate chronic pain in the elderly  due to its favorable safety profile
Do dementia patients know what they are saying?
These communication hiccups happen all the time to most people, but dementia affects the brain so that language problems become more noticeable. Someone with Alzheimer’s, for instance, won’t remember phrases or be able to learn new phrases. Slang and common expressions become hard or even impossible to remember.
Is tramadol OK for the elderly?
Use any form of tramadol with extreme caution in patients 75 years and older. The elderly may be especially prone to side effects with tramadol due to lowered liver or kidney function and reduced metabolism or excretion.