Pain treatment of agitation in patients with dementia: a systematic review
Article first published online: 9 FEB 2011
Copyright © 2011 John Wiley & Sons, Ltd.
International Journal of Geriatric Psychiatry
Volume 26, Issue 10, pages 1012–1018, October 2011
How to Cite
Husebo, B.S., Ballard, C. and Aarsland, D. (2011), Pain treatment of agitation in patients with dementia: a systematic review. Int. J. Geriat. Psychiatry, 26: 1012–1018. doi: 10.1002/gps.2649
- Issue published online: 8 SEP 2011
- Article first published online: 9 FEB 2011
- Manuscript Accepted: 20 SEP 2010
- Manuscript Received: 28 JUN 2010
- Norwegian Research Council, University of Bergen. Grant Number: 189439
- The Kavli's Research Centre for Aging and Dementia, Haraldplass Diakonian Hospital, Bergen, Norway
- behavioral disturbances;
- pain treatment
Advancing age is associated with high prevalence of both dementia and pain. Dementia is frequently accompanied by distressing behavioral and psychological symptoms, including agitation and aggression, particularly in nursing home patients. The etiology of agitation is multifactorial. It has been suggested that un-diagnosed and untreated pain may contribute to agitation in people with dementia. If this is correct, individual pain treatment could be of benefit in ameliorating agitation and other behavioral changes in people with dementia.
The objective of this paper is to conduct a systematic review of studies of whether pain medication can improve agitation in people with dementia.
A systematic search of the PubMed and Cochrane databases for the period 1992–2010 was performed, using dementia, agitation, aggression, depression, behavioral disturbances, behavioral and psychological symptoms (BPSD), pain, pain assessment, pain treatment, pain management, and analgesics as search terms. Inclusion criteria were: prospective studies including patients with dementia, interventions focusing on pain reduction, inclusion of a control condition, and outcome measures including agitation or other related behavioral disturbances.
Only three controlled trials were identified; all were cross-over trials, and two included small sample sizes (<50). Findings were inconsistent, and although some correlations were reported, these did not support the hypothesis that pain management reduced agitation.
There is a profound dearth of rigorous studies of the effect of pain treatment in patients with dementia and agitation. The available studies do not support the hypothesis that pain management reduces agitation in nursing-home patients with dementia. Randomized, controlled parallel-group studies are needed. Copyright © 2011 John Wiley & Sons, Ltd.