Does systematic pain control improve agitation in demented patients?

January 01, 0001

Does systematic pain control improve agitation in demented patients?

These Norwegian and UK researchers examined the use of a systematic pain treatment approach in nursing home patients with dementia and whether it decreased behavioral disturbances via a randomized controlled trial. Enrollees with moderate to severe dementia and clinically significant behavioral disturbances were randomized to a stepwise protocol for pain using acetaminophen, morphine, buprenorphine transdermal patch, and pregabaline (n=175) or to usual treatment (n=177). Agitation was measured using Cohen- Mansfield agitation inventory and other inventories.

The researchers found: "Agitation was significantly reduced in the intervention group compared with control group after eight weeks: the average reduction in scores for agitation was 17% (treatment effect estimate -7.0). Treatment of pain was also significantly beneficial for the overall severity of neuropsychiatric symptoms (-9.0) and pain (-1.3), but the groups did not differ significantly for activities of daily living or cognition."

The researchers concluded: "A systematic approach to the management of pain significantly reduced agitation in residents of nursing homes with moderate to severe dementia. Effective management of pain can play an important part in the treatment of agitation and could reduce the number of unnecessary prescriptions for psychotropic drugs in this population."

This randomized controlled trial finds a systematic and stepwise method of pain control decreases behavioral outbursts in demented patients in extended care facilities.

For the full abstract, click here.

BMJ 343:d4065, 17 July 2011 © 2011 BMJ Publishing Group Ltd.
Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial. Bettina S Husebo, Clive Ballard, Reidun Sandvik, Odd Bjarte Nilsen, Dag Aarsland. Correspondence to C Ballard: [email protected]

Category: A. General/Unspecified. Keywords: pain, dementia, agitation, acetaminophen, morphine, randomized controlled trial, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 5 August 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.