This article was published online on 19 December 2013. An omission from the Acknowledgements section was subsequently identified. This notice is included in the online and print versions to indicate that both have been corrected [7 July 2014]
Efficacy of pain treatment on mood syndrome in patients with dementia: a randomized clinical trial†
Article first published online: 19 DEC 2013
© 2013 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
International Journal of Geriatric Psychiatry
Volume 29, Issue 8, pages 828–836, August 2014
How to Cite
2014), Efficacy of pain treatment on mood syndrome in patients with dementia: a randomized clinical trial, Int J Geriatr Psychiatry, 29, pages 828–836, doi: 10.1002/gps.4063, , , and (
- Issue published online: 16 JUL 2014
- Article first published online: 19 DEC 2013
- Manuscript Accepted: 21 NOV 2013
- Manuscript Revised: 11 NOV 2013
- Manuscript Received: 11 JUN 2013
- Norwegian Research Council. Grant Number: 189439
- University of Bergen. Grant Number: 09/1568
- nursing home
Depression is common in nursing home (NH) patients with dementia, and often clustered with anxiety and other mood symptoms. An association between pain and depressive symptoms has been reported, but the impact of pain management on depression and other mood symptoms has not been investigated.
Secondary analyses of a cluster randomized clinical trial examine the response of dementia-related mood symptoms to a Stepwise Protocol of Treating Pain.
Three-hundred fifty-two patients with moderate and severe dementia and significant behavioural disturbances, related to 60 clusters (i.e. clusters defined as single independent NH units) in 18 NHs of Western Norway, were included. All patients in the intervention group received individual daily pain treatment with paracetamol, extended release morphine, buprenorphine transdermal patch or pregabaline for 8 weeks, with additional follow-up assessment 4 weeks after completion of the intervention. Clusters randomized to control received usual treatment. A mood cluster consisting of depression, anxiety, sleep disorders, apathy and appetite items from the Neuropsychiatric Inventory-Nursing Home (NPI-NH) was the primary outcome.
Analysed by Mann–Whitney U-tests, Stepwise Protocol of Treating Pain conferred significant benefit in treatment of the NPI-NH mood cluster (F = 13.4, df = 1;299, p < 0.001) and depression (F = 2.0, df = 1;301, p = 0.025). Further analyses highlighted improvements in apathy (F = 5.3, df = 1;300, p = 0.017), night-time behaviours (F = 3.1, df = 1;301, p = 0.050), and appetite items (F = 11.6, df = 1;301, p = 0.005), but not irritability (p = 0.092) and anxiety (p = 0.125).
Mood symptoms including depression significantly improved with pain treatment, emphasizing the importance of more rigorous treatment of pain in agitated people with dementia. Findings have potentially immediate clinical relevance. © 2013 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.