Approximately 50 million people around the globe live with dementia, of whom 50 percent experience regular pain. Although pain is one of the most common symptoms among dementia patients, it is also one of the most undertreated.
Since individuals with late-stage dementia struggle to self-report their symptoms, pain can be challenging to recognize and in turn, effectively treat. Unfortunately, new research shows that the painkiller buprenorphine may make dementia symptoms worse.
Dementia Patients Experience Pain, Yet Are Often Undertreated
Pain is a very personal experience. In some cases, pain cannot only cause an unpleasant sensory experience but also result in emotional distress as well. The most common causes of pain are the same for all older people, including those with dementia.
These causes range from symptoms of osteoarthritis to painful ulcers. Often resulting in behavioral issues, pain is typically misunderstood as a symptom of dementia. For example, calling out for help may not be due to dementia itself, but rather an underlying issue, such as stiff muscles or constipation.
As stated in this study, published in the Journal of Alzheimer’s Disease, pain is under-detected and undertreated. Unfortunately, chronic pain when left untreated can result in depression, agitation, and aggression. The researchers concluded that self-report is not a sufficient way to assess pain in people with dementia.
Study Finds the Painkiller Buprenorphine May Do More Harm Than Good
Buprenorphine is an opioid that is commonly used to treat dementia patients. However, researchers have found that this painkiller may cause a number of side effects, including increased confusion and sedation.
One of the researchers stated, “In a person who has used this treatment over time with no sign of adverse symptoms, there may not be a cause for concern.”
However, based on their research, the team believes that doctors need to be mindful of the use and dosage of this painkiller. For this study, a team from the UK and Norway studied people with advanced dementia for 13 weeks. In total, 44 patients received a patch containing buprenorphine. An addition 45 individuals were given a placebo patch.
Neither the individuals nor their caregivers knew which patch they received. After taking variables into account, such as sex, pain, age, and depression, those taking the buprenorphine patch were 24 times more likely to drop out of the trial. They were also more likely to experience undesirable side effects. Those at the highest risk of adverse effects were those taking both antidepressants and buprenorphine.
The researchers concluded that painkillers are not a one-size-fits-all treatment. This latest research highlights the importance of balancing the potential side-effects with a drug’s beneficial impact. Overall, when prescribing opioid pain relief to patients with dementia, careful consideration must be taken.
How Will You Know If Your Loved One Is In Pain?
If you believe that your loved one is distressed, it is important that you take action. The following approaches will help you better assess whether or not your loved one is in pain.
- Ask them directly — In some cases, even patients living with moderate to advanced dementia are still able to provide information on their pain levels. Instead of asking, are you in pain, ask them if they are sore or if a suspected area hurts. Remember, you do not want to overload your loved one with questions. If they appear confused, try again later, as this may lead to increased agitation and distress.
- Know the signs — If you spend a lot of time with your loved one, you will likely notice if they are in discomfort. Although some people will scream out in pain, others will become quiet and withdrawn. Also, be mindful of any past conditions. Did your loved one once suffer from migraines? Do they have a history of fractures? It is helpful to keep a list of all past occurrences so that you can better understand their specific needs.
- Use a standardized tool — If possible, use a tool that can better assess your loved one’s pain intensity. There are a number of options, such as a numerical rating scale or a verbal descriptor scale. Also, consider the Pain Assessment in Advanced Dementia Scale (PAINAD).
The BrainTest® App
If you are currently concerned that you or your loved one are experiencing the early warning signs of dementia, please consider the BrainTest® app. This scientifically-validated tool can help you detect any early signs of Alzheimer’s and other cognitive impairments. Unlike pain, changes in cognition are not subjective. If at any point you feel as though your level of cognitive thinking has become impaired, early intervention is critical.
For more information on pain management, please refer to the following: