Alison R Anderson1, W Larkin Iversen2, Michael A Carter3, Karen O Moss2, Ronald L Cowan4, Todd B Monroe2. 1. Vanderbilt University School of Nursing, Nashville, Tennessee. 2. The Ohio State University College of Nursing, Columbus, Ohio. 3. University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee. 4. University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee.
Abstract
BACKGROUND: Pain continues to be underrecognized and undertreated in Alzheimer's disease (AD) while existing guidance about pain assessment and management in dementia is not widespread. Brain regions involved in pain processing and modulation are damaged during AD, and the pain experience in AD is not well understood. Experimental pain studies using psychophysics can further our understanding of the pain experience in AD, which may lead to improved assessment and management of pain in people living with AD. OBJECTIVE: A systematic review was conducted to explicate the current understanding of experimentally evoked pain in AD from primary research using psychophysical methods. DATA SOURCES: Peer-reviewed publications were found via PubMed, CINAHL, and PsycINFO. A total of 18 primary research, peer-reviewed full articles that met inclusion criteria were included, representing 929 total participants. CONCLUSIONS: Experimentally evoked pain in people with AD demonstrates that despite cognitive impairment and a reduced ability to effectively communicate, individuals with AD experience pain similar to or more unpleasant than cognitively intact older adults. This may mean amplified pain unpleasantness in people with AD. IMPLICATIONS FOR PRACTICE: Our current best practices need to be widely disseminated and put into clinical practice. Self-report of pain continues to be the gold standard, but it is ineffective for noncommunicative patients and those unable to understand pain scales or instructions because of memory/cognitive impairment. Instead, pain treatment should be ethically initiated based on patient reports and behaviors, caregiver/surrogate reports, review of the medical record for painful conditions, analgesic trials, and regular reassessments.
BACKGROUND: Pain continues to be underrecognized and undertreated in Alzheimer's disease (AD) while existing guidance about pain assessment and management in dementia is not widespread. Brain regions involved in pain processing and modulation are damaged during AD, and the pain experience in AD is not well understood. Experimental pain studies using psychophysics can further our understanding of the pain experience in AD, which may lead to improved assessment and management of pain in people living with AD. OBJECTIVE: A systematic review was conducted to explicate the current understanding of experimentally evoked pain in AD from primary research using psychophysical methods. DATA SOURCES: Peer-reviewed publications were found via PubMed, CINAHL, and PsycINFO. A total of 18 primary research, peer-reviewed full articles that met inclusion criteria were included, representing 929 total participants. CONCLUSIONS: Experimentally evoked pain in people with AD demonstrates that despite cognitive impairment and a reduced ability to effectively communicate, individuals with AD experience pain similar to or more unpleasant than cognitively intact older adults. This may mean amplified pain unpleasantness in people with AD. IMPLICATIONS FOR PRACTICE: Our current best practices need to be widely disseminated and put into clinical practice. Self-report of pain continues to be the gold standard, but it is ineffective for noncommunicative patients and those unable to understand pain scales or instructions because of memory/cognitive impairment. Instead, pain treatment should be ethically initiated based on patient reports and behaviors, caregiver/surrogate reports, review of the medical record for painful conditions, analgesic trials, and regular reassessments.
Authors: Leonie J Cole; Maria Gavrilescu; Leigh A Johnston; Stephen J Gibson; Michael J Farrell; Gary F Egan Journal: Eur J Pain Date: 2011-01-22 Impact factor: 3.931
Authors: Miriam Kunz; Margot W M de Waal; Wilco P Achterberg; Lydia Gimenez-Llort; Frank Lobbezoo; Elisabeth L Sampson; Annelore H van Dalen-Kok; Ruth Defrin; Sara Invitto; Ljubica Konstantinovic; Joukje Oosterman; Laura Petrini; Jenny T van der Steen; Liv-Inger Strand; Marina de Tommaso; Sandra Zwakhalen; Bettina S Husebo; Stefan Lautenbacher Journal: Eur J Pain Date: 2019-10-13 Impact factor: 3.931
Authors: Todd B Monroe; Stephen J Gibson; Stephen P Bruehl; John C Gore; Mary S Dietrich; Paul Newhouse; Sebastian Atalla; Ronald L Cowan Journal: BMC Med Date: 2016-05-10 Impact factor: 8.775