Pain in Advanced Stages of Dementia: The Perspective of Medical Students
Abstract
:1. Introduction
2. Materials and Methods
- What are the clinical symptoms of pain in patients with advanced dementia?
- Which scales would you use while assessing the pain in patients with advanced dementia?
- Are the pain treatment rules in patients with advanced dementia similar to those without cognitive impairment? If yes, why? If no, why?
- facial expression,
- negative vocalization,
- body language,
- changes in activity patterns,
- changes in interpersonal interactions, and
- mental status changes.
- pain assessment methods and pain scales recommended for use in the general population, including subjects with mild and moderate cognitive impairment (Visual Analogue Scales (VAS), Numerical Rating Scale (NRS), or Face Pain Scale (FPS) [16].
- students who answered yes,
- students who answered no, and
- students who answered yes and no.
- correct,
- partially correct, and
- wrong.
Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
- Chen, Y.H.; Lin, L.C.; Watson, R. Validating nurses’ and nursing assistants’ report of assessing pain in older people with dementia. J. Clin. Nurs. 2010, 19, 42–52. [Google Scholar] [CrossRef] [PubMed]
- Björkman, M.; Sorva, A.; Tilvis, R. Vitamin D supplementation has no major effect on pain or pain behavior in bedridden geriatric patients with advanced dementia. Aging Clin. Exp. Res. 2008, 20, 316–321. [Google Scholar] [CrossRef] [PubMed]
- McAuliffe, L.; Brown, D.; Fetherstonhaugh, D. Pain and dementia: An overview of the literature. Int. J. Older People Nurs. 2012, 7, 219–226. [Google Scholar] [CrossRef]
- Tsai, I.P.; Jeong, S.Y.; Hunter, S. Pain Assessment and Management for Older Patients with Dementia in Hospitals: An Integrative Literature Review. Pain Manag. Nurs. 2018, 19, 54–71. [Google Scholar] [CrossRef] [PubMed]
- Ung, A.; Salamonson, Y.; Hu, W.; Gallego, G. Assessing knowledge, perceptions and attitudes to pain management among medical and nursing students: A review of the literature. Br. J. Pain 2016, 10, 8–21. [Google Scholar] [CrossRef]
- AGS Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J. Am. Geriatr. Soc. 2002, 50, S205–S224. [Google Scholar] [CrossRef]
- Monroe, T.B.; Misra, S.K.; Habermann, R.C.; Dietrich, M.S.; Cowan, R.L.; Simmons, S.F. Pain reports and pain medication treatment in nursing home residents with and without dementia. Geriatr. Gerontol. Int. 2014, 14, 541–548. [Google Scholar] [CrossRef] [PubMed]
- Van Dalen-Kok, A.H.; Pieper, M.J.; de Waal, M.W.; Lukas, A.; Husebo, B.S.; Achterberg, W.P. Association between pain, neuropsychiatric symptoms, and physical function in dementia: A systematic review and meta-analysis. BMC Geriatr. 2015, 15, 49. [Google Scholar] [CrossRef]
- Husebo, B.S.; Ballard, C.; Sandvik, R.; Nilsen, O.B.; Aarsland, D. Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: Cluster randomised clinical trial. BMJ 2011, 343, d4065. [Google Scholar] [CrossRef]
- Achterberg, W.P.; Pieper, M.J.; van Dalen-Kok, A.H.; de Waal, M.W.; Husebo, B.S.; Lautenbacher, S.; Kunz, M.; Scherder, E.J.; Corbett, A. Pain management in patients with dementia. Clin. Interv. Aging 2013, 8, 1471–1482. [Google Scholar] [CrossRef] [Green Version]
- Cravello, L.; Di Santo, S.; Varrassi, G.; Benincasa, D.; Marchettini, P.; de Tommaso, M.; Shofany, J.; Assogna, F.; Perotta, D.; Palmer, K.; et al. Chronic Pain in the Elderly with Cognitive Decline: A Narrative Review. Pain Ther. 2019. [Google Scholar] [CrossRef] [PubMed]
- Jones, K.R.; Fink, R.; Pepper, G.; Hutt, E.; Vojir, C.P.; Scott, J.; Clark, L.; Mellis, K. Improving nursing home staff knowledge and attitudes about pain. Gerontologist 2004, 44, 469–478. [Google Scholar] [CrossRef] [PubMed]
- Zwakhalen, S.M.; Hamers, J.P.; Peijnenburg, R.H.; Berger, M.P. Nursing staff knowledge and beliefs about pain in elderly nursing home residents with dementia. Pain Res. Manag. 2007, 12, 177–184. [Google Scholar] [CrossRef] [PubMed]
- Abbey, J.; De Bellis, A.; Piller, N.; Esterman, A.; Giles, L.; Parker, D.; Lowcay, B. Abbey Pain Scale: A 1-minute numerical indicator for people with end-stage dementia. funded by the JH & JD Gunn Medical Research Foundation 1998–2002. Int. J. Palliat. Nurs. 2004, 10, 6–13. [Google Scholar]
- Lefebvre-Chapiro, S. The DOLOPLUS 2 scale—Evaluating pain in the elderly. Eur. J. Palliat. Care 2001, 8, 191–194. [Google Scholar] [CrossRef]
- McClean, W. Identifying and managing pain in people with dementia. Nurs. Res. Care 2003, 5, 2–10. [Google Scholar] [CrossRef]
- Husebo, B.S.; Achterberg, W.; Flo, E. Identifying and Managing Pain in People with Alzheimer’s Disease and Other Types of Dementia: A Systematic Review. CNS Drugs 2016, 30, 481–497. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Barber, J.B.; Gibson, S.J. Treatment of chronic non-malignant pain in the elderly: Safety considerations. Drug Saf. 2009, 32, 457–474. [Google Scholar] [CrossRef] [PubMed]
- Kunz, M.; Scharmann, S.; Hemmeter, U.; Schepelmann, K.; Lautenbacher, S. The facial expression of pain in patients with dementia. Pain 2007, 133, 221–228. [Google Scholar] [CrossRef] [PubMed]
- Zalmay, P.; de C Williams, A.C. How do medical students use and understand pain rating scales? Scand. J. Pain. 2017, 15, 68–72. [Google Scholar] [CrossRef] [Green Version]
- Herr, K. Pain assessment strategies in older patients. J. Pain. 2011, 12, S3–S13. [Google Scholar] [CrossRef]
- Kovach, C.R.; Logan, B.R.; Joosse, L.L.; Noonan, P.E. Failure to identify behavioral symptoms of people with dementia and the need for follow-up physical assessment. Res. Gerontol. Nurs. 2012, 5, 89–93. [Google Scholar] [CrossRef]
- Gilmore-Bykovskyi, A.L.; Bowers, B.J. Understanding nurses’ decisions to treat pain in nursing home residents with dementia. Res. Gerontol. Nurs. 2013, 6, 127–138. [Google Scholar] [CrossRef]
- Brorson, H.; Plymouth, H.; Örmon, K.; Bolmsjö, I. Pain relief at the end of life: nurses’ experiences regarding end-of-life pain relief in patients with dementia. Pain Manag. Nurs. 2014, 15, 315–323. [Google Scholar] [CrossRef]
- Tan, E.C.K.; Visvanathan, R.; Hilmer, S.N.; Vitry, A.I.; Quirke, L.; Emery, T.; Robson, L.; Shortt, T.; Sheldrick, S.; Lee, S.S.W.L.; et al. Analgesic use, pain and daytime sedation in people with and without dementia in aged care facilities: A cross-sectional, multisite, epidemiological study protocol. BMJ Open 2014, 4, e005757. [Google Scholar] [CrossRef]
- Habiger, T.F.; Flo, E.; Achterberg, W.P.; Husebo, B.S. The interactive relationship between pain, psychosis, and agitation in people with dementia: Results from a cluster-randomised clinical trial. Behav. Neurol. 2016, 7036415. [Google Scholar] [CrossRef]
- Barry, H.E.; Parsons, C.; Peter Passmore, A.; Hughes, C.M. An exploration of nursing home managers’ knowledge of and attitudes towards the management of pain in residents with dementia. Int. J. Geriatr. Psychiatry 2012, 27, 1258–1266. [Google Scholar] [CrossRef]
- Pautex, S.; Michon, A.; Guedira, M.; Emond, H.; Le Lous, P.; Samaras, D.; Michel, J.P.; Herrmann, F.; Giannakopoulos, P.; Gold, G. Pain in severe dementia: Self-assessment or observational scales? J. Am. Geriatr. Soc. 2006, 54, 1040–1045. [Google Scholar] [CrossRef]
Answer YES | Answer NO with Correct Argumentation | Answer NO with Incorrect Argumentation |
---|---|---|
“yes, they feel pain in the same way” | “no, because the symptoms may be atypical and it is more difficult to assess pain in patients with dementia” | “no, due to side effects, another metabolism” |
“yes, dementia does not affect the action of drugs” | “no, because there are problems with communication and self-medication” | “no, more medicines that the patient takes, slowed metabolism [cause] interactions, other pharmacodynamics and pharmacokinetics; the underlying somatic causes are also different” |
“yes, goals, medications and dosage [are] the same” | “no; the patient is unable to describe the pain, the emphasis [should be] on verifying the treatment of pain” | “no, due to the high burden of other conditions, which causes taking of a broad spectrum of drugs and drug interactions; they are more likely to have side effects; lower doses are often effective” |
“yes, patients with dementia suffer the same as those without, and one should seek the same pain control” | ”no, because the treatment is based on observation of the patient, a different manifestation of pain, lack of reporting of the need to increase the dose by the patient, difficult to assess the pain, patients [are] difficult to determine the doses” | “no, we do not give drugs orally” |
“yes, dementia does not affect the choice of drugs, the most important is pain relief’ | “no, the NRS scale is unreliable, [it is] more difficult to assess the effects of treatment and contact with the patient” | “no, lower doses are needed, more carefully introduced” |
“yes, we use the analgesic ladder plus observation of the patient for doses, adverse effects and effects of treatment as well as chronic and breakthrough pain” | “[the patient] is unable to take the medication on their own, one cannot rely on the patient’s opinion on the effectiveness of the treatment, more difficult assessment of pain and of dosage” | “no, doses are higher in the group of patients with advanced dementia” |
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Neumann-Podczaska, A.; Tobis, S.; Yermukhanova, L.; Wieczorowska-Tobis, K. Pain in Advanced Stages of Dementia: The Perspective of Medical Students. Medicina 2019, 55, 116. https://doi.org/10.3390/medicina55050116
Neumann-Podczaska A, Tobis S, Yermukhanova L, Wieczorowska-Tobis K. Pain in Advanced Stages of Dementia: The Perspective of Medical Students. Medicina. 2019; 55(5):116. https://doi.org/10.3390/medicina55050116
Chicago/Turabian StyleNeumann-Podczaska, Agnieszka, Slawomir Tobis, Lyudmila Yermukhanova, and Katarzyna Wieczorowska-Tobis. 2019. "Pain in Advanced Stages of Dementia: The Perspective of Medical Students" Medicina 55, no. 5: 116. https://doi.org/10.3390/medicina55050116