1
|
Resnick B, Boltz M, Galik E, Kuzmik A, Drazich BF, McPherson R, Wells CL, Renn C, Dorsey SG, Ellis J. Factors Associated With Function-Focused Care Among Hospitalized Older Adults Living With Dementia. Crit Care Nurs Q 2023; 46:299-309. [PMID: 37226921 PMCID: PMC10508903 DOI: 10.1097/cnq.0000000000000466] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This article reports a study that was designed to describe the incidence of pain among older hospitalized patients with dementia and to evaluate the factors that influence pain among these individuals. It was hypothesized that function, behavioral and psychological symptoms of dementia, delirium, pain treatment, and patient exposure to care interventions would be associated with pain. Patients who performed more functional activities had less delirium. They also experienced higher quality-of-care interactions and were less likely to have pain. The findings from this study support the relationship between function, delirium, and quality-of-care interactions and pain. It suggests that it may be useful to encourage patients with dementia to engage in functional and physical activity to prevent or manage pain. This study serves as a reminder to avoid neutral or negative care interactions among patients with dementia as a strategy to mediate delirium and pain.
Collapse
Affiliation(s)
- Barbara Resnick
- School of Nursing (Drs Resnick, Galik, Drazich, Wells, Renn, and Dorsey, and Ms Ellis) and School of Medicine (Dr McPherson), University of Maryland, Baltimore; and Penn State University, University Park, Pennsylvania (Drs Boltz and Kuzmik)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Wandrey JD, Behnel N, Weidner E, Dummin U, von Dincklage F, Tafelski S. Behaviour-based pain scales: Validity and interrater reliability of BPS-NI and PAINAD-G on general wards. Eur J Pain 2023; 27:201-211. [PMID: 36326568 DOI: 10.1002/ejp.2051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/26/2022] [Accepted: 10/30/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Measuring pain intensity in patients unable to communicate is a challenge on general wards. Observation-based pain scoring tools have been used for patients with dementia or in critically ill intensive care unit (ICU) patients. However, there is no established or validated assessment tool for non-ICU patients without dementia related cognitive deficiencies who cannot communicate. The "Behavioural Pain Scale Non-Intubated" (BPS-NI) and the "Pain Assessment In Advanced Dementia-German" (PAINAD-G) are potential tools to fill this gap. METHODS This study was performed with verbal non-ICU patients on general wards at Charité Berlin. Two assessors independently rated pain intensity using the BPS-NI and the PAINAD-G along with patients' self-ratings on the Numeric Rating Scale (NRS). The interrater-reliability of BPS-NI and PAINAD-G was calculated and ROC-analyses were performed to identify cut-off values for medium and intense pain for each score. Effectiveness was calculated using percentage agreement. In total, 126 patients were included into analysis. RESULTS The BPS-NI showed substantial congruence in interrater-reliability (Cohens-Kappa 0.71), whereas the PAINAD-G showed moderate congruence (Kappa 0.48). Based on ROC-analyses, for medium pain levels a cut-off 4 (BPS-NI) or 2 (PAINAD-G) and for severe pain levels cut-off 5 (BPS-NI) and 3 (PAINAD-G) would result in good accordance with self-reported NRS for pain. CONCLUSION The BPS-NI shows a good validity in measuring pain intensity in patients on general wards and may possibly be used for patients unable to communicate. Using defined cut-off values for BPS-NI and PAINAD-G, clinically relevant pain intensities in patients can reliably be detected. SIGNIFICANCE Measuring the pain intensity in patients unable to communicate is a common challenge on general wards. This study assessed reliability and applicability BPS-NI and the PAINAD-G in a general ward setting. Furthermore, it provides cut-off values in order to estimate pain intensity and support analgesic response.
Collapse
Affiliation(s)
- Jan D Wandrey
- Department of Anaesthesiology and Operative Intensive Care, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Niklas Behnel
- Department of Anaesthesiology and Operative Intensive Care, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Elisa Weidner
- Department of Anaesthesiology and Operative Intensive Care, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ulrike Dummin
- Department of Anaesthesiology and Operative Intensive Care, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Falk von Dincklage
- Department of Anaesthesiology and Operative Intensive Care, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Anesthesia, Critical Care, Emergency and Pain Medicine, Ferdinand-Sauerbruch-Strasse, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Sascha Tafelski
- Department of Anaesthesiology and Operative Intensive Care, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| |
Collapse
|
3
|
Blanton H, Reddy PH, Benamar K. Chronic pain in Alzheimer's disease: Endocannabinoid system. Exp Neurol 2023; 360:114287. [PMID: 36455638 PMCID: PMC9789196 DOI: 10.1016/j.expneurol.2022.114287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/09/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022]
Abstract
Chronic pain, one of the most common reasons adults seek medical care, has been linked to restrictions in mobility and daily activities, dependence on opioids, anxiety, depression, sleep deprivation, and reduced quality of life. Alzheimer's disease (AD), a devastating neurodegenerative disorder (characterized by a progressive impairment of cognitive functions) in the elderly, is often co-morbid with chronic pain. AD is one of the most common neurodegenerative disorders in the aged population. The reported prevalence of chronic pain is 45.8% of the 50 million people with AD. As the population ages, the number of older people who experience AD and chronic pain will also increase. The current treatment options for chronic pain are limited, often ineffective, and have associated side effects. This review summarizes the role of the endocannabinoid system in pain, its potential role in chronic pain in AD, and addresses gaps and future directions.
Collapse
Affiliation(s)
- Henry Blanton
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX 79430, USA
| | - P Hemachandra Reddy
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX 79430, USA; Internal Medicine Department, Texas Tech University Health Sciences Center, 3601 4th Street, Lubbock, TX 79430, USA
| | - Khalid Benamar
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX 79430, USA.
| |
Collapse
|
4
|
Anderson AR, Monroe TB, Dietrich MS, Bruehl SP, Iversen WL, Cowan RL, Failla MD. Increased pain unpleasantness and pain-related fMRI activation in the periaqueductal gray in Alzheimer's disease. FRONTIERS IN PAIN RESEARCH 2022; 3:914473. [PMID: 36387417 PMCID: PMC9650512 DOI: 10.3389/fpain.2022.914473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/07/2022] [Indexed: 01/25/2023] Open
Abstract
Background Pain continues to be underrecognized and undertreated in people with Alzheimer's disease (AD). The periaqueductal gray (PAG) is essential to pain processing and modulation yet is damaged by AD. While evidence exists of altered neural processing of pain in AD, there has not been a focused investigation of the PAG during pain in people with AD. Purpose To investigate the role of the PAG in sensory and affective pain processing for people living with AD. Methods Participants from a larger study completed pain psychophysics assessments and then a perceptually-matched heat pain task (warmth, mild, and moderate pain) during a functional MRI scan. In this cross-sectional study, we examined blood oxygenation level-dependent (BOLD) responses in the PAG and other pain-related regions in participants with AD (n = 18) and cognitively intact older adults (age- and sex-matched, n = 18). Associations of BOLD percent signal change and psychophysics were also examined. Results There were significant main effects of AD status on the temperature needed to reach each perception of warmth or pain, where people with AD reached higher temperatures. Furthermore, participants with AD rated mild and moderate pain as more unpleasant than controls. PAG BOLD activation was greater in AD relative to controls during warmth and mild pain percepts. No significant differences were found for moderate pain or in other regions of interest. Greater PAG activation during mild pain was associated with higher affective/unpleasantness ratings of mild pain in participants with AD but not in controls. Conclusion Results suggest a role for the PAG in altered pain responses in people with AD. The PAG is the primary source of endogenous opioid pain inhibition in the neuroaxis, thus, altered PAG function in AD suggests possible changes in descending pain inhibitory circuits. People with AD may have a greater risk of suffering from pain compared to cognitively intact older adults.
Collapse
Affiliation(s)
- Alison R. Anderson
- Center for Complex Care, Self-Management and Healthy Aging, The Ohio State University, College of Nursing, Columbus, OH, United States
- School of Nursing, Vanderbilt University, Nashville, TN, United States
| | - Todd B. Monroe
- Center for Complex Care, Self-Management and Healthy Aging, The Ohio State University, College of Nursing, Columbus, OH, United States
- School of Nursing, Vanderbilt University, Nashville, TN, United States
- Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mary S. Dietrich
- School of Nursing, Vanderbilt University, Nashville, TN, United States
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Stephen P. Bruehl
- Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - W. Larkin Iversen
- Center for Complex Care, Self-Management and Healthy Aging, The Ohio State University, College of Nursing, Columbus, OH, United States
| | - Ronald L. Cowan
- Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, United States
- Departments of Psychiatry and Anatomy and Neurobiology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN, United States
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Michelle D. Failla
- Center for Complex Care, Self-Management and Healthy Aging, The Ohio State University, College of Nursing, Columbus, OH, United States
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| |
Collapse
|
5
|
Ma S, Huang H, Zhong Z, Zheng H, Li M, Yao L, Yu B, Wang H. Effect of acupuncture on brain regions modulation of mild cognitive impairment: A meta-analysis of functional magnetic resonance imaging studies. Front Aging Neurosci 2022; 14:914049. [PMID: 36212046 PMCID: PMC9540390 DOI: 10.3389/fnagi.2022.914049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/31/2022] [Indexed: 11/23/2022] Open
Abstract
Background As a non-pharmacological therapy, acupuncture has significant efficacy in treating Mild Cognitive Impairment (MCI) compared to pharmacological therapies. In recent years, advances in neuroimaging techniques have provided new perspectives to elucidate the central mechanisms of acupuncture for MCI. Many acupuncture brain imaging studies have found significant improvements in brain function after acupuncture treatment of MCI, but the underlying mechanisms of brain regions modulation are unclear. Objective A meta-analysis of functional magnetic resonance imaging studies of MCI patients treated with acupuncture was conducted to summarize the effects of acupuncture on the modulation of MCI brain regions from a neuroimaging perspective. Methods Using acupuncture, neuroimaging, magnetic resonance, and Mild Cognitive Impairment as search terms, PubMed, EMBASE, Web of Science, Cochrane Library, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effects (DARE), Google Scholar, China National Knowledge Infrastructure (CNKI), China Biology Medicine disk (CBM disk), Wanfang and Chinese Scientific Journal Database (VIP) for brain imaging studies on acupuncture on MCI published up to April 2022. Voxel-based neuroimaging meta-analysis of fMRI data was performed using voxel-based d Mapping with Permutation of Subject Images (SDM-PSI), allowing for Family-Wise Error Rate (FWER) correction correction for correction multiple comparisons of results. Subgroup analysis was used to compare the differences in brain regions between the acupuncture treatment group and other control groups. Meta-regression was used to explore demographic information and altered cognitive function effects on brain imaging outcomes. Linear models were drawn using MATLAB 2017a, and visual graphs for quality evaluation were produced using R software and RStudio software. Results A total of seven studies met the inclusion criteria, with 94 patients in the treatment group and 112 patients in the control group. All studies were analyzed using the regional homogeneity (ReHo) method. The experimental design of fMRI included six task state studies and one resting-state study. The meta-analysis showed that MCI patients had enhanced activity in the right insula, left anterior cingulate/paracingulate gyri, right thalamus, right middle frontal gyrus, right median cingulate/paracingulate gyri, and right middle temporal gyrus brain regions after acupuncture treatment. Further analysis of RCT and longitudinal studies showed that Reho values were significantly elevated in two brain regions, the left anterior cingulate/paracingulate gyrus and the right insula, after acupuncture. The MCI group showed stronger activity in the right supramarginal gyrus after acupuncture treatment compared to healthy controls. Meta-regression analysis showed that the right anterior thalamic projection ReHo index was significantly correlated with the MMSE score after acupuncture treatment in all MCI patients. Conclusions Acupuncture therapy has a modulating effect on the brain regions of MCI patients. However, due to the inadequate experimental design of neuroimaging studies, multi-center neuroimaging studies with large samples are needed better to understand the potential neuroimaging mechanisms of acupuncture for MCI. In addition, machine learning algorithm-based predictive models for evaluating the efficacy of acupuncture for MCI may become a focus of future research. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022287826, identifier: CRD 42022287826.
Collapse
Affiliation(s)
- Shiqi Ma
- College of Acupuncture and Massage, Changchun University of Chinese Medicine, Changchun, China
| | - Haipeng Huang
- Northeast Asian Institute of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Zhen Zhong
- College of Acupuncture and Massage, Changchun University of Chinese Medicine, Changchun, China
| | - Haizhu Zheng
- College of Acupuncture and Massage, Changchun University of Chinese Medicine, Changchun, China
| | - Mengyuan Li
- College of Acupuncture and Massage, Changchun University of Chinese Medicine, Changchun, China
| | - Lin Yao
- College of Acupuncture and Massage, Changchun University of Chinese Medicine, Changchun, China
| | - Bin Yu
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Hongfeng Wang
- Northeast Asian Institute of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| |
Collapse
|
6
|
Krysa K, Kowalczyk E, Borysowski J, Lachota M, Pasierski T. Exclusion of older adults from clinical trials in cancer-related pain. Front Med (Lausanne) 2022; 9:945481. [PMID: 35991635 PMCID: PMC9385985 DOI: 10.3389/fmed.2022.945481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Pain is one of the most common symptoms in cancer patients including older adults. The objective of this study was to evaluate the enrollment criteria that can limit the inclusion of older adults in clinical trials concerning cancer-related pain (CRP). The study included 356 trials registered with ClinicalTrials.gov. Our primary outcome measures were the proportion of trials that excluded patients based on upper age limits (80 years of age or less), strict organ-specific exclusion criteria, broad and imprecise criteria, and inadequate performance score. One hundred and twenty-six trials (35.4%) had upper age limits. Strict exclusion criteria were used in 95 (26.7%) trials. Broad and imprecise exclusion criteria were listed in 57 (16.2%) trials. Low performance score was used as an exclusion criterion in 4 trials (1.1%). Overall, in 241 trials (67.7%) there was either an upper age limit or at least one strict or broad and imprecise exclusion criterion, or a criterion involving the performance status. The odds of excluding older adults were significantly higher in certain neoplasm types, study objectives, intervention types, and center locations. In conclusion, considerable proportion of recent clinical trials concerning CRP either explicitly exclude older adults or create high risk of such exclusion which substantially limits the evidence base for the treatment of such patients in clinical practice. Sponsors and investigators should consider careful modification of the enrollment criteria to improve the inclusion of older individuals who make up the major proportion of cancer patients population.
Collapse
Affiliation(s)
| | - Ewa Kowalczyk
- Clinical Research Development Centre, Medical Research Agency, Warsaw, Poland
| | - Jan Borysowski
- Department of Clinical Immunology, Medical University of Warsaw, Warsaw, Poland
- Centre for Studies on Research Integrity, Institute of Law Studies, Polish Academy of Sciences, Warsaw, Poland
- *Correspondence: Jan Borysowski
| | - Mieszko Lachota
- Department of Clinical Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Pasierski
- Department of Medical Ethics and Palliative Medicine, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
7
|
Rouch I, Edjolo A, Laurent B, Dartigues JF, Amieva H. Chronic pain and long-term dementia risk in older adults: Results from a 24-year longitudinal study. Int J Geriatr Psychiatry 2022; 37. [PMID: 35434855 DOI: 10.1002/gps.5713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/13/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Chronic pain (CP) was associated with cognitive impairment in previous studies. However, the longitudinal association between CP and dementia remains under debate. We aimed to assess the prospective link between CP and long-term dementia risk in a population-based cohort of older participants, considering covariables linked to CP and cognitive functioning. METHODS The study sample was selected from the PAQUID study, an ongoing cohort of older community-dwellers aged 65 years and over at baseline; Information regarding CP and analgesics consumption was collected using questionnaires. Dementia was clinically assessed every 2 years. The population was divided into 4 groups according to CP and analgesic drugs intake (CP+/A+, CP+/A-, CP-/A+, CP-/A-). An illness-death model was used to estimate the link between CP and incident dementia risk controlled for sex, educational level, comorbidities, depression, antidepressant drugs and analgesics. RESULTS Five hundred ninety three participants (364 women) who completed a CP questionnaire, were included. They were followed-up over 24 years (mean follow-up: 11.3 years, SD 7.3). A total of 223 participants (32.5%) had CP, among them 88 (38.6%) took analgesic drugs. Compared to CP-/A- group, CP+/A+ participants had a higher risk of developing dementia in the univariate model (hazard ratio (HR) = 1.73, 95%CI:1.18-2.56; p = 0.0051). However, these results did not persist in the multivariate models (aHR = 1.23, 95%CI:0.88-1.73; p = 0.23). No significant risk for dementia were observed in CP-/A+ and CP+/A- (HR = 1.30, 95%CI:0.84-2.01; p = 0.23 and HR = 1.36, 95%CI:0.95-1.96; p = 0.09, respectively). CONCLUSION Our results failed to show a significant relationship between the presence of CP and long-term dementia risk, suggesting that the cognitive decline associated with CP observed in the literature does not appear to be related to Alzheimer's disease or related disorders.
Collapse
Affiliation(s)
- Isabelle Rouch
- Memory Clinical and Research Center of Saint Etienne (CMRR), Neurology Unit, University Hospital of Saint Etienne, Saint Etienne, France
- INSERM, U1219, Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France
| | - Arlette Edjolo
- Memory Clinical and Research Center of Saint Etienne (CMRR), Neurology Unit, University Hospital of Saint Etienne, Saint Etienne, France
- INSERM, U1219, Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France
| | - Bernard Laurent
- Memory Clinical and Research Center of Saint Etienne (CMRR), Neurology Unit, University Hospital of Saint Etienne, Saint Etienne, France
- INSERM, U1028; CNRS, UMR5292; Neuropain Team, Lyon Neuroscience Research Center, Lyon, France
| | | | - Hélène Amieva
- INSERM, U1219, Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France
| |
Collapse
|
8
|
Chen LY, Tsai TH, Ho A, Li CH, Ke LJ, Peng LN, Lin MH, Hsiao FY, Chen LK. Predicting neuropsychiatric symptoms of persons with dementia in a day care center using a facial expression recognition system. Aging (Albany NY) 2022; 14:1280-1291. [PMID: 35113806 PMCID: PMC8876896 DOI: 10.18632/aging.203869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/17/2022] [Indexed: 11/25/2022]
Abstract
Background: Behavioral and psychological symptoms of dementia (BPSD) affect 90% of persons with dementia (PwD), resulting in various adverse outcomes and aggravating care burdens among their caretakers. This study aimed to explore the potential of artificial intelligence-based facial expression recognition systems (FERS) in predicting BPSDs among PwD. Methods: A hybrid of human labeling and a preconstructed deep learning model was used to differentiate basic facial expressions of individuals to predict the results of Neuropsychiatric Inventory (NPI) assessments by stepwise linear regression (LR), random forest (RF) with importance ranking, and ensemble method (EM) of equal importance, while the accuracy was determined by mean absolute error (MAE) and root-mean-square error (RMSE) methods. Results: Twenty-three PwD from an adult day care center were enrolled with ≥ 11,500 FERS data series and 38 comparative NPI scores. The overall accuracy was 86% on facial expression recognition. Negative facial expressions and variance in emotional switches were important features of BPSDs. A strong positive correlation was identified in each model (EM: r = 0.834, LR: r = 0.821, RF: r = 0.798 by the patientwise method; EM: r = 0.891, LR: r = 0.870, RF: r = 0.886 by the MinimPy method), and EM exhibited the lowest MAE and RMSE. Conclusions: FERS successfully predicted the BPSD of PwD by negative emotions and the variance in emotional switches. This finding enables early detection and management of BPSDs, thus improving the quality of dementia care.
Collapse
Affiliation(s)
- Liang-Yu Chen
- Aging and Health Research Center, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei, Taiwan.,uAge Day Care Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Andy Ho
- Value Lab, Acer Incorporated, New Taipei City, Taiwan
| | - Chun-Hsien Li
- Value Lab, Acer Incorporated, New Taipei City, Taiwan
| | - Li-Ju Ke
- uAge Day Care Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Ning Peng
- Aging and Health Research Center, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei, Taiwan
| | - Ming-Hsien Lin
- Aging and Health Research Center, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, National Taiwan University, Taipei, Taiwan.,School of Pharmacy, National Taiwan University, Taipei, Taiwan.,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei, Taiwan.,Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
| |
Collapse
|
9
|
Beach PA, Humbel A, Dietrich MS, Bruehl S, Cowan RL, Moss KO, Monroe TB. A Cross-Sectional Study of Pain Sensitivity and Unpleasantness in People with Vascular Dementia. PAIN MEDICINE 2021; 23:1231-1238. [PMID: 34791388 DOI: 10.1093/pm/pnab327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/26/2021] [Accepted: 11/04/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Advanced age holds higher risk of both pain and dementia, with many studies finding dementia often heightens sensitivity to pain. VaD is the second most common type of dementia. Only a few observational or retrospective studies have examined pain responsiveness in VaD, suggesting it may increase pain unpleasantness (i.e., pain affect). This study compared thermal pain psychophysics between a cohort of vascular dementia (VaD) patients and healthy control (HC) subjects. DESIGN Single center, cross-sectional, between-subjects design. SUBJECTS Verbally communicative, probable VaD patients (N = 23) and age- and sex-matched HC (N = 23). METHODS A thermal psychophysics protocol assessed "mild pain" and "moderate pain" thresholds (oC temperature) and associated unpleasantness ratings (0-20 scale) in both VaD and HC groups. Psychophysics were compared between groups by way of a mixed-effects analysis, controlling for depressive symptoms. RESULTS There were no significant differences between groups for pain thresholds (main effect p = 0.086, Cohen's d: mild = 0.55, moderate = 0.27). However, unpleasantness ratings were higher in the VaD group compared to HC (main effect p = 0.003; mild pain p = 0.022, Cohen's d = 0.79; moderate pain p = 0.057, Cohen's d = 0.6). CONCLUSIONS These results are consistent with prior observational findings suggesting VaD may make patients more susceptible to pain, particularly its affective component.
Collapse
Affiliation(s)
- Paul A Beach
- Bachelors of Science in Nursing Program, The Ohio State University College of Nursing, Columbus, OH
| | - Angela Humbel
- Bachelors of Science in Nursing Program, The Ohio State University College of Nursing, Columbus, OH
| | - Mary S Dietrich
- Department of Biostatistics, Vanderbilt University School of Medicine and School of Nursing, Nashville, TN
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Ronald L Cowan
- Departments of Psychiatry and Anatomy and Neurobiology, Center for Addiction Science; College of Medicine; The University of Tennessee Health Science Center, Memphis, TN
| | - Karen O Moss
- Center for Health Outcomes in Medicine, The Ohio State University College of Medicine, Columbus, OH.,Center for Healthy Aging, The Ohio State University College of Nursing, Columbus, OH
| | - Todd B Monroe
- Center for Healthy Aging, The Ohio State University College of Nursing, Columbus, OH
| |
Collapse
|
10
|
Ogawa T, Seki K, Tachibana T, Hayashi H, Moross J, Kristensen MT, Shirasawa S. Early recovery of basic mobility under femoral nerve block after hip fracture surgery - A propensity score matched pilot study. Injury 2021; 52:3382-3387. [PMID: 34344517 DOI: 10.1016/j.injury.2021.07.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Previous studies have shown better pain reduction utilizing femoral nerve block (FNB) in patients who underwent hip fracture surgery. However, few studies have focused on the recovery of physical function after FNB, and most studies excluded patients with dementia. We investigated the association between FNB performed in the operating room and the recovery of physical function after hip fracture surgery, including patients with dementia. METHODS A total of 103 patients with a mean age of 87.4 years who underwent hip fracture surgery under spinal anesthesia between July 2015 and December 2017 (46 patients receiving a single injection of FNB and 57 standard care) were enrolled. Patients with FNB versus standard care were matched by a propensity score to adjust for patient characteristics. An anesthesiologist performed FNB with 20ml of 0.2% ropivacaine, and the standard care group received intravenous 1000 mg acetaminophen or 50mg flurbiprofen once after surgery. After matching, 78 patients were analyzed. Our primary outcome was 3-day cumulated ambulation score (CAS, 0-18 points) and secondary outcomes were 1-day CAS on postoperative day 1-3 and length of hospital stay. We also stratified patient groups based on the presence of dementia and fracture type. RESULTS Patients undergoing FNB had significantly better 3-day CAS compared to standard care (mean [SD], 8.72 [3.42] vs 7.33 [2.62]; mean difference, 1.38 [95%CI; 0.03 - 2.74]; p = 0.048) and 1-day CAS on postoperative day two (mean [SD], 3.10 [1.39] vs 2.56 [0.94]; mean difference, 0.54 [0.01 - 1.07]; p = 0.049). Length of hospital stay did not significantly differ among the two groups (p = 0.65). Larger positive effect was likely to be seen for patients with a femoral neck fractures and for those without dementia. CONCLUSIONS Patients who underwent surgery with spinal anesthesia plus FNB had better ambulatory status early after hip fracture surgery compared to patients not offered FNB. The beneficial association between FNB and ambulatory status was likely to be observed especially in patients with femoral neck fracture and without dementia.
Collapse
Affiliation(s)
- Takahisa Ogawa
- Department of Orthopedic Surgery, Suwa Central Hospital, 4300 Tamagawa, Chino, Nagano 391-8503, Japan; Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Keiko Seki
- Department of Anestheology, Suwa Central Hospital, Nagano, Japan
| | - Tetsuya Tachibana
- Second Department of Orthopedic Surgery, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Hiroto Hayashi
- Department of Public Health in Global Health, Graduate School of Medicine, Tokyo Medical and Dental University, Japan
| | - Janelle Moross
- Office for Global Education and Career Development, International Exchange Center, Tokyo Medical and Dental University, Japan.
| | - Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research Copenhagen (PMR-C), Departments of Physiotherapy and Orthopaedic Surgery, Copenhagen University Hospital Amager-Hvidovre & Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Shinichi Shirasawa
- Department of Orthopedic Surgery, Suwa Central Hospital, 4300 Tamagawa, Chino, Nagano 391-8503, Japan.
| |
Collapse
|
11
|
Pain Processing in Cognitive Impairment and Its Association with Executive Function and Memory: Which Neurocognitive Factor Takes the Lead? Brain Sci 2021; 11:brainsci11101319. [PMID: 34679384 PMCID: PMC8533810 DOI: 10.3390/brainsci11101319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 02/07/2023] Open
Abstract
It is well established that individuals with cognitive impairment present with disturbed forms of pain processing of still unknown origin. As a neurocognitive factor, executive functions have become favored candidates for explanation. For further insights, we aimed at comparing executive functions and memory in their association with parameters indicating onset and escalation of pain perception. Subjective ratings of experimentally induced pressure pain applied in ascending series were assessed in older individuals with (N = 32) and without mild cognitive impairments (MCI) (N = 32). We investigated whether executive functioning (Trail Making Test-B (TMT-B), semantic fluency) or memory (word list and figure recall) were more closely linked to the onset and the escalation of pain. For the MCI group, a strong linkage between pain responses and the TMT-B could be found, i.e., poor test performance was associated with weak pain onset but strong pain escalation. The contribution of memory functions was less substantial and systematic. The prominent role of executive function for pain processing in individuals with MCI could be replicated by a test of cognitive flexibility. This lack of adaptability let individuals with MCI be less vigilant to pain at the beginning but allows for escalating pain in the further course. Thus, being first not sufficiently prepared and later overwhelmed as regards pain may be an early problem in MCI individuals with reduced executive functioning.
Collapse
|
12
|
Forrester S, Mbrah A, Lapane KL. A Latent Approach to Understanding Pain in Nursing Home Residents Who are Unable to Self-Report Pain. J Pain Res 2021; 14:2283-2293. [PMID: 34345184 PMCID: PMC8324982 DOI: 10.2147/jpr.s302305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/15/2021] [Indexed: 11/24/2022] Open
Abstract
Context Pain assessment in people with cognitive impairment is challenging. Objective The study sought to 1) identify pain subgroups based on staff-assessed pain, agitated and reactive behavior, functional status, and symptoms of depression; and 2) understand if cognitive impairment was associated with transitions between pain subgroups at nursing home admission, 3 months, and 6 months. Methods Using national Minimum Data Set 3.0 data (2011–2016), we included 26,816 newly admitted residents with staff-assessed pain at admission, 3 months, and 6 months. Pain subgroups were identified by latent class analysis at each time point. Transitions between pain subgroups were described using latent transition analysis. Results Five latent statuses of pain were identified at admission: “Behavioral and Severe Depression” (prevalence stable, severe or worsening cognitive impairment: 11%, mild/moderate or improved cognitive impairment: 10%), “Functional” (21%; 25%), “Physical” (22%; 23%), “Behavioral” (23%, 19%), and “Low” (23%; 24%). Regardless of change in cognitive status, most residents remained in the same pain latent class. Among residents with stable, severe or worsening cognitive impairment, 11% in the “Behavioral” class transitioned to the “Behavioral and Severe Depression” class by 3 months. Fewer residents transitioned between latent classes in the 3- to 6-month period (>80% remained in their 3-month class). Conclusion For nursing home residents unable to self-report pain, consideration of additional indicators including functioning, depressive symptoms, and agitation may be useful in identifying pain subgroups. Longitudinal changes in the pain subgroups over 6 months post-admission highlight that residents with severe cognitive impairment may be at risk for worsening pain.
Collapse
Affiliation(s)
- Sarah Forrester
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Attah Mbrah
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
13
|
Mylius V, Möller JC, Bohlhalter S, Ciampi de Andrade D, Perez Lloret S. Diagnosis and Management of Pain in Parkinson's Disease: A New Approach. Drugs Aging 2021; 38:559-577. [PMID: 34224103 DOI: 10.1007/s40266-021-00867-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 12/27/2022]
Abstract
Pain is a frequent and disabling non-motor feature of Parkinson's disease (PD). The recently proposed PD Pain Classification System (PD-PCS) allows for an association of pain with PD to be determined before being allocated to the main pain mechanism (i.e. nociceptive, neuropathic, and nociplastic). In this article, previous studies on treatments for pain in PD are summarized according to the pain mechanisms. A mechanistic approach to treatment is discussed. We suggest that the first step should be optimizing dopaminergic therapy before other therapy is started. When these treatments remain unsuccessful, further causes of pain must be considered. The role of drugs, invasive treatments, and physiotherapeutic interventions are discussed with a focus on older PD patients and considering polypharmacy, altered pharmacokinetics, and comorbidities.
Collapse
Affiliation(s)
- Veit Mylius
- Department of Neurology, Center for Neurorehabilitation, 7317, Valens, Switzerland. .,Department of Neurology, Philipps University, Marburg, Germany. .,Department of Neurology, Kantonsspital, St. Gallen, Switzerland.
| | - Jens Carsten Möller
- Department of Neurology, Philipps University, Marburg, Germany.,Parkinson Center, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Stephan Bohlhalter
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland.,Department of Neurology, University of Zurich, Zurich, Switzerland
| | - Daniel Ciampi de Andrade
- Centro de Dor, Departamento de Neurologia da Faculdade de Medicina da, Universidade de Sao Paulo, Sao Paulo, Brazil.,Instituto do Cancer de Sao Paulo, Octavio Frias de Oliveira, Sao Paulo, Brazil.,Hospital das Clinicas, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Santiago Perez Lloret
- LIM 62, Biomedical Research Center (CAECIHS-UAI), National Research Council (CONICET), Buenos Aires, Argentina.,Facultad de Ciencias Médicas, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina.,Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
14
|
Bunk S, Zuidema S, Koch K, Lautenbacher S, De Deyn PP, Kunz M. Pain processing in older adults with dementia-related cognitive impairment is associated with frontal neurodegeneration. Neurobiol Aging 2021; 106:139-152. [PMID: 34274699 DOI: 10.1016/j.neurobiolaging.2021.06.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/23/2021] [Accepted: 06/12/2021] [Indexed: 12/14/2022]
Abstract
Experimental pain research has shown that pain processing seems to be heightened in dementia. It is unclear which neuropathological changes underlie these alterations. This study examined whether differences in pressure pain sensitivity and endogenous pain inhibition (conditioned pain modulation (CPM)) between individuals with a dementia-related cognitive impairment (N=23) and healthy controls (N=35) are linked to dementia-related neurodegeneration. Pain was assessed via self-report ratings and by analyzing the facial expression of pain using the Facial Action Coding System. We found that cognitively impaired individuals show decreased CPM inhibition as assessed by facial responses compared to healthy controls, which was mediated by decreased gray matter volume in the medial orbitofrontal and anterior cingulate cortex in the patient group. This study confirms previous findings of intensified pain processing in dementia when pain is assessed using non-verbal responses. Our findings suggest that a loss of pain inhibitory functioning caused by structural changes in prefrontal areas might be one of the underlying mechanisms responsible for amplified pain responses in individuals with a dementia-related cognitive impairment.
Collapse
Affiliation(s)
- Steffie Bunk
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kathrin Koch
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, Martinsried, Germany
| | | | - Peter P De Deyn
- Alzheimer Center Groningen, Department Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Miriam Kunz
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Medical Psychology and Sociology, University of Augsburg, Augsburg, Germany
| |
Collapse
|
15
|
Atee M, Morris T, Macfarlane S, Cunningham C. Pain in Dementia: Prevalence and Association With Neuropsychiatric Behaviors. J Pain Symptom Manage 2021; 61:1215-1226. [PMID: 33068708 DOI: 10.1016/j.jpainsymman.2020.10.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 01/09/2023]
Abstract
CONTEXT Pain is linked to behaviors and psychological symptoms of dementia (BPSD); however, it often remains underrecognized in this population. OBJECTIVES We aimed to investigate the prevalence and intensity of pain in people living in aged care homes with BPSD and by dementia subtypes and the association between pain intensity and BPSD. METHODS A 1-year retrospective cross-sectional analysis was conducted on BPSD and the presence of pain in referrals to a national BPSD support service using the Neuropsychiatric Inventory and PainChek®, respectively. Referrals were categorized into two groups: pain group and no pain group. RESULTS Of the 479 referrals (81.9 ± 8.3 years old) included in the analysis, two-thirds (65.6%) had pain identified, with almost half (48.4%) of these categorized as experiencing moderate-severe pain. Pain was highly prevalent (range: 54.6-78.6%) in all subtypes of dementia, particularly in mixed dementia and dementia with Lewy bodies. Compared with the no pain group, the pain group had 25.3% more neuropsychiatric behaviors, 33.6% higher total severity of these behaviors, and 31.4% higher total distress caused to caregivers. For all results, effect sizes were small to medium (η²p = 0.04-0.06). Despite a high prevalence of aggressive or agitated behaviors across the entire group, the pain group was 3.8 times more likely to experience these behaviors than referrals not in pain. CONCLUSION There is a strong need to consider the possibility of pain as a contributor to behavioral changes in aged care residents living with dementia.
Collapse
Affiliation(s)
- Mustafa Atee
- The Dementia Centre, HammondCare, Wembley, Western Australia, Australia; Faculty of Health Sciences, School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, Western Australia, Australia.
| | - Thomas Morris
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia
| | - Stephen Macfarlane
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia; Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Colm Cunningham
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia; School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
16
|
Hassan T, Seus D, Wollenberg J, Weitz K, Kunz M, Lautenbacher S, Garbas JU, Schmid U. Automatic Detection of Pain from Facial Expressions: A Survey. IEEE TRANSACTIONS ON PATTERN ANALYSIS AND MACHINE INTELLIGENCE 2021; 43:1815-1831. [PMID: 31825861 DOI: 10.1109/tpami.2019.2958341] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Pain sensation is essential for survival, since it draws attention to physical threat to the body. Pain assessment is usually done through self-reports. However, self-assessment of pain is not available in the case of noncommunicative patients, and therefore, observer reports should be relied upon. Observer reports of pain could be prone to errors due to subjective biases of observers. Moreover, continuous monitoring by humans is impractical. Therefore, automatic pain detection technology could be deployed to assist human caregivers and complement their service, thereby improving the quality of pain management, especially for noncommunicative patients. Facial expressions are a reliable indicator of pain, and are used in all observer-based pain assessment tools. Following the advancements in automatic facial expression analysis, computer vision researchers have tried to use this technology for developing approaches for automatically detecting pain from facial expressions. This paper surveys the literature published in this field over the past decade, categorizes it, and identifies future research directions. The survey covers the pain datasets used in the reviewed literature, the learning tasks targeted by the approaches, the features extracted from images and image sequences to represent pain-related information, and finally, the machine learning methods used.
Collapse
|
17
|
Lawn T, Aman Y, Rukavina K, Sideris-Lampretsas G, Howard M, Ballard C, Ray Chaudhuri K, Malcangio M. Pain in the neurodegenerating brain: insights into pharmacotherapy for Alzheimer disease and Parkinson disease. Pain 2021; 162:999-1006. [PMID: 33239526 PMCID: PMC7977618 DOI: 10.1097/j.pain.0000000000002111] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/18/2020] [Accepted: 10/08/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Timothy Lawn
- Centre for Neuroimaging Sciences, The Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Yahyah Aman
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, Lørenskog, Norway
| | - Katarina Rukavina
- The Maurice Wohl Clinical Neuroscience Institute, The Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | - George Sideris-Lampretsas
- Wolfson Centre for Age Related Diseases, The Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Matthew Howard
- Centre for Neuroimaging Sciences, The Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | | | - Kallol Ray Chaudhuri
- The Maurice Wohl Clinical Neuroscience Institute, The Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Marzia Malcangio
- Wolfson Centre for Age Related Diseases, The Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| |
Collapse
|
18
|
Anderson AR, Iversen WL, Carter MA, Moss KO, Cowan RL, Monroe TB. Experimentally evoked pain in Alzheimer's disease. J Am Assoc Nurse Pract 2021; 34:18-25. [PMID: 33731557 PMCID: PMC9118535 DOI: 10.1097/jxx.0000000000000580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Pain continues to be underrecognized and undertreated in Alzheimer's disease (AD) while existing guidance about pain assessment and management in dementia is not widespread. Brain regions involved in pain processing and modulation are damaged during AD, and the pain experience in AD is not well understood. Experimental pain studies using psychophysics can further our understanding of the pain experience in AD, which may lead to improved assessment and management of pain in people living with AD. OBJECTIVE A systematic review was conducted to explicate the current understanding of experimentally evoked pain in AD from primary research using psychophysical methods. DATA SOURCES Peer-reviewed publications were found via PubMed, CINAHL, and PsycINFO. A total of 18 primary research, peer-reviewed full articles that met inclusion criteria were included, representing 929 total participants. CONCLUSIONS Experimentally evoked pain in people with AD demonstrates that despite cognitive impairment and a reduced ability to effectively communicate, individuals with AD experience pain similar to or more unpleasant than cognitively intact older adults. This may mean amplified pain unpleasantness in people with AD. IMPLICATIONS FOR PRACTICE Our current best practices need to be widely disseminated and put into clinical practice. Self-report of pain continues to be the gold standard, but it is ineffective for noncommunicative patients and those unable to understand pain scales or instructions because of memory/cognitive impairment. Instead, pain treatment should be ethically initiated based on patient reports and behaviors, caregiver/surrogate reports, review of the medical record for painful conditions, analgesic trials, and regular reassessments.
Collapse
Affiliation(s)
| | | | - Michael A. Carter
- University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee
| | - Karen O. Moss
- The Ohio State University College of Nursing, Columbus, Ohio
| | - Ronald L. Cowan
- University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
| | - Todd B. Monroe
- The Ohio State University College of Nursing, Columbus, Ohio
| |
Collapse
|
19
|
Gregory J. Holistic pain assessment in older people and older people living with dementia. Nurs Older People 2020; 33:e1293. [PMID: 33403836 DOI: 10.7748/nop.2021.e1293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/09/2022]
Abstract
Pain occurs in a wide range of diseases and long-term conditions associated with ageing and can affect every aspect of an individual's life, reducing their ability to recover, their independence and their quality of life. The assessment of pain is an important aspect of nurses' role and requires them to obtain detailed information on how the older person experiences pain and how pain is affecting their life. However, there are many challenges to effective pain assessment in older people, including challenges concerning communication and cognition. This article provides an overview of pain assessment in older people, particularly those living with dementia, based on the author's expertise and on relevant literature, notably the recently revised UK national guidelines on the assessment of pain in older people.
Collapse
Affiliation(s)
- Julie Gregory
- East Lancashire Hospitals NHS Trust, Blackburn, England
| |
Collapse
|
20
|
Shigihara Y, Hoshi H, Fukasawa K, Ichikawa S, Kobayashi M, Sakamoto Y, Negishi K, Haraguchi R, Konno S. Resting-State Magnetoencephalography Reveals Neurobiological Bridges Between Pain and Cognitive Impairment. Pain Ther 2020; 10:349-361. [PMID: 33095348 PMCID: PMC8119570 DOI: 10.1007/s40122-020-00213-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/15/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction Pain has been identified as a risk factor for cognitive dysfunction, which in turn affects pain perception. Although pain, cognitive dysfunction, and their interaction are clinically important, the neural mechanism connecting the two phenomena remains unclear. Methods The resting-state brain activity of 38 participants was measured using magnetoencephalography before and after the patients underwent selective nerve root block (SNRB) for the treatment of their pain. We then assessed the extent to which these data correlated with the subjective levels of pain experienced by the patients across SNRB based on the visual analogue scale and the cognitive status of the patients measured after SNRB using the Japanese versions of the Mini-Mental State Examination (MMSE-J). Results Slow oscillations (delta) in the right precentral gyrus, right middle temporal gyrus, and left superior frontal gyrus were negatively correlated with the subjective level of pain, and fast oscillations (gamma) in the right insular cortex and right middle temporal gyrus before SNRB were negatively correlated with the MMSE-J score afterwards. These correlations disappeared after SNRB. Conclusion The presently observed changes in neural activity, as indicated by oscillation changes, might represent the transient bridge between pain and cognitive dysfunction in patients with severe pain. Our findings underscore the importance of treating pain before a transient diminishment of cognitive function becomes persistent.
Collapse
Affiliation(s)
- Yoshihito Shigihara
- Precision Medicine Centre, Hokuto Hospital, Obihiro, Japan. .,Precision Medicine Centre, Kumagaya General Hospital, Kumagaya, Japan.
| | - Hideyuki Hoshi
- Precision Medicine Centre, Hokuto Hospital, Obihiro, Japan
| | | | - Sayuri Ichikawa
- Clinical Laboratory, Kumagaya General Hospital, Kumagaya, Japan
| | - Momoko Kobayashi
- Precision Medicine Centre, Kumagaya General Hospital, Kumagaya, Japan
| | - Yuki Sakamoto
- Precision Medicine Centre, Kumagaya General Hospital, Kumagaya, Japan
| | | | - Rika Haraguchi
- Clinical Laboratory, Kumagaya General Hospital, Kumagaya, Japan
| | - Shin Konno
- Department of Orthopaedics, Kumagaya General Hospital, Kumagaya, Japan
| |
Collapse
|
21
|
Borg C, Sala E, Chainay H, Labouré J, Getenet JC, Dorey JM, Laurent B, Rouch I. How do patients with Alzheimer's disease imagine their pain? Eur J Pain 2020; 25:466-472. [PMID: 33078485 DOI: 10.1002/ejp.1685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Pain is underdiagnosed and undertreated in patients with Alzheimer's disease (AD). Pain management is of major importance in this population to limit behavioural and functional consequences. Our study aimed to assess the capacity of AD patients to represent pain using a questionnaire exploring daily painful situations and to determine the most appropriate pain scale assessment. METHODS Twenty-eight patients with mild AD, 21 with moderate AD and 28 matched controls underwent the Situation Pain Questionnaire (SP-Q) and assessed imaginary pain with four pain scales. Two scores were compared between the three groups: the P(A) discrimination score and the response bias β score. P(A) reflects the degree of discrimination between high-pain and low-pain events, whereas the β score means the degree to which situations are considered as painful. RESULTS Our results showed that AD patients hardly discriminated the high- from low-pain events. Compared to controls, the mean P(A) score was significantly lower for Mild AD (p < 0.03) and Moderate AD (p < 0.004). In addition, the β score indicated that the response bias is higher for AD patients (p < 0.01) in that they overestimated the level of pain. CONCLUSION The present results suggest that patients with Mild and Moderate AD are able to recognize and assess an imagined painful situation even though their pain tolerance is lower than that of controls. The pain scales used should be chosen according to the cognitive, sensorial and personal profiles of the patients. SIGNIFICANCE The present research is significant because it examines how patients with Alzheimer's disease understand and assess painful situations. Cognitive impairments can modify this ability. Pain is a sensory and subjective experience and to define its feeling can help us in our clinical practice.
Collapse
Affiliation(s)
- Céline Borg
- Neurology/Neuropsychology CMRR Unit, Hospital Nord, Saint Priest-en-Jarez, France.,Psychology Department, University of Lyon, Lyon, France
| | - Emilie Sala
- Neurology/Neuropsychology CMRR Unit, Hospital Nord, Saint Priest-en-Jarez, France
| | - Hanna Chainay
- EMC Laboratory (EA 3082), Université Lyon 2, University of Lyon, Bron, France
| | - Julien Labouré
- Neurology/Neuropsychology CMRR Unit, Hospital Nord, Saint Priest-en-Jarez, France
| | - Jean-Claude Getenet
- Neurology/Neuropsychology CMRR Unit, Hospital Nord, Saint Priest-en-Jarez, France
| | | | - Bernard Laurent
- Neurology/Neuropsychology CMRR Unit, Hospital Nord, Saint Priest-en-Jarez, France.,Neuropain Team, INSERM U1028, Lyon Neuroscience Research Center, Lyon, France
| | - Isabelle Rouch
- Neurology/Neuropsychology CMRR Unit, Hospital Nord, Saint Priest-en-Jarez, France
| |
Collapse
|
22
|
Dube CE, Morrison RA, Mack DS, Jesdale BM, Nunes AP, Liu SH, Lapane KL. Prevalence of Pain on Admission by Level of Cognitive Impairment in Nursing Homes. J Pain Res 2020; 13:2663-2672. [PMID: 33116808 PMCID: PMC7586014 DOI: 10.2147/jpr.s270689] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To provide contemporary estimates of pain by level of cognitive impairment among US nursing home residents without cancer. METHODS Newly admitted US nursing home residents without cancer assessed with the Minimum Data Set 3.0 at admission (2010-2016) were eligible (n=8,613,080). The Cognitive Function Scale was used to categorize level of cognitive impairment. Self-report or staff-assessed pain was used based on a 5-day look-back period. Estimates of adjusted prevalence ratios (aPR) were derived from modified Poisson models. RESULTS Documented prevalence of pain decreased with increased levels of cognitive impairment in those who self-reported pain (68.9% no/mild, 32.9% severe) and those with staff-assessed pain (50.6% no/mild, 37.2% severe staff-assessed pain). Relative to residents with no/mild cognitive impairment, pharmacologic pain management was less prevalent in those with severe cognitive impairment (self-reported: 51.3% severe vs 76.9% in those with no/mild; staff assessed: 52.0% severe vs 67.7% no/mild). CONCLUSION Pain was less frequently documented in those with severe cognitive impairment relative to those with no/mild impairments. Failure to identify pain may result in untreated or undertreated pain. Interventions to improve evaluation of pain in nursing home residents with cognitive impairment are needed.
Collapse
Affiliation(s)
- Catherine E Dube
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Reynolds A Morrison
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Deborah S Mack
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Bill M Jesdale
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Anthony P Nunes
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Shao-Hsien Liu
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
23
|
Castillo LI, Browne ME, Hadjistavropoulos T, Prkachin KM, Goubran R. Automated vs. manual pain coding and heart rate estimations based on videos of older adults with and without dementia. J Rehabil Assist Technol Eng 2020; 7:2055668320950196. [PMID: 33014413 PMCID: PMC7509718 DOI: 10.1177/2055668320950196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/22/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction Technological advances have allowed for the estimation of physiological indicators from video data. FaceReader™ is an automated facial analysis software that has been used widely in studies of facial expressions of emotion and was recently updated to allow for the estimation of heart rate (HR) using remote photoplethysmography (rPPG). We investigated FaceReader™-based heart rate and pain expression estimations in older adults in relation to manual coding by experts. Methods Using a video dataset of older adult patients with and without dementia, we assessed the relationship between FaceReader’s™ HR estimations against a well-established Video Magnification (VM) algorithm during baseline and pain conditions. Furthermore, we examined the correspondence between the Facial Action Coding System (FACS)-based pain scores obtained through FaceReader™ and manual coding. Results FaceReader’s™ HR estimations were correlated with VM algorithm in baseline and pain conditions. Non-verbal FaceReader™ pain scores and manual coding were also highly correlated despite discrepancies between the FaceReader™ and manual coding in the absolute value of scores based on pain-related facial action coding of the events preceding and following the pain response. Conclusions Compared to expert manual FACS coding and optimized VM algorithm, FaceReader™ showed good results in estimating HR values and non-verbal pain scores.
Collapse
Affiliation(s)
- Louise Ir Castillo
- Department of Psychology, University of Regina, Regina, Canada.,Centre on Aging and Health, University of Regina, Regina, Canada
| | - M Erin Browne
- Department of Psychology, University of Regina, Regina, Canada.,Centre on Aging and Health, University of Regina, Regina, Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology, University of Regina, Regina, Canada.,Centre on Aging and Health, University of Regina, Regina, Canada
| | - Kenneth M Prkachin
- Department of Psychology, University of Northern British Columbia, British Columbia, Canada
| | - Rafik Goubran
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Canada
| |
Collapse
|
24
|
Uddin MS, Mamun AA, Sumsuzzman DM, Ashraf GM, Perveen A, Bungau SG, Mousa SA, El-Seedi HR, Bin-Jumah MN, Abdel-Daim MM. Emerging Promise of Cannabinoids for the Management of Pain and Associated Neuropathological Alterations in Alzheimer's Disease. Front Pharmacol 2020; 11:1097. [PMID: 32792944 PMCID: PMC7387504 DOI: 10.3389/fphar.2020.01097] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022] Open
Abstract
Alzheimer's disease (AD) is an irreversible chronic neurodegenerative disorder that occurs when neurons in the brain degenerate and die. Pain frequently arises in older patients with neurodegenerative diseases including AD. However, the presence of pain in older people is usually overlooked with cognitive dysfunctions. Most of the times dementia patients experience moderate to severe pain but the development of severe cognitive dysfunctions tremendously affects their capability to express the presence of pain. Currently, there are no effective treatments against AD that emphasize the necessity for increasing research to develop novel drugs for treating or preventing the disease process. Furthermore, the prospective therapeutic use of cannabinoids in AD has been studied for the past few years. In this regard, targeting the endocannabinoid system has considered as a probable therapeutic strategy to control several associated pathological pathways, such as mitochondrial dysfunction, excitotoxicity, oxidative stress, and neuroinflammation for the management of AD. In this review, we focus on recent studies about the role of cannabinoids for the treatment of pain and related neuropathological changes in AD.
Collapse
Affiliation(s)
- Md. Sahab Uddin
- Department of Pharmacy, Southeast University, Dhaka, Bangladesh
- Pharmakon Neuroscience Research Network, Dhaka, Bangladesh
| | - Abdullah Al Mamun
- Department of Pharmacy, Southeast University, Dhaka, Bangladesh
- Pharmakon Neuroscience Research Network, Dhaka, Bangladesh
| | | | - Ghulam Md Ashraf
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Asma Perveen
- Glocal School of Life Sciences, Glocal University, Saharanpur, India
| | - Simona G. Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Shaker A. Mousa
- Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, New York, NY, United States
| | - Hesham R. El-Seedi
- Division of Pharmacognosy, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
- Department of Chemistry, Faculty of Science, Menoufia University, Shebin El-Koom, Egypt
| | - May N. Bin-Jumah
- Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Mohamed M. Abdel-Daim
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
- Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
| |
Collapse
|
25
|
Morrison RA, Jesdale BM, Dubé CE, Nunes AP, Bova CA, Liu SH, Lapane KL. Differences in Staff-Assessed Pain Behaviors among Newly Admitted Nursing Home Residents by Level of Cognitive Impairment. Dement Geriatr Cogn Disord 2020; 49:243-251. [PMID: 32610321 PMCID: PMC7704920 DOI: 10.1159/000508096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/22/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Pain is common among nursing home residents with cognitive impairment and dementia. Pain is often underdiagnosed and undertreated, which may lead to adverse health outcomes. Nonverbal behaviors are valid indicators of pain, but the extent to which these behavioral expressions vary across levels of cognitive impairment is unknown. This study sought to examine differences in the prevalence of pain behaviors among nursing home residents with varying levels of cognitive impairment. METHODS The Minimum Data Set, version 3.0, was used to identify newly admitted nursing home residents with staff-assessed pain (2010-2016, n = 1,036,806). Staff-assessed pain behaviors included nonverbal sounds, vocal complaints, facial expressions, and protective body movements or postures over a 5-day look-back period for residents unable or unwilling to self-report pain. The Cognitive Function Scale was used to categorize residents as having no/mild, moderate, or severe cognitive impairment. Modified Poisson models provided adjusted prevalence ratios (aPR) and 95% CIs. RESULTS Compared to residents with no/mild cognitive impairments (any pain: 48.1%), residents with moderate cognitive impairment (any pain: 42.4%; aPR: 0.94 [95% CI 0.93-0.95]) and severe cognitive impairment (any pain: 38.4%; aPR: 0.86 [95% CI 0.85-0.88]) were less likely to have any pain behavior documented. Vocal pain behaviors were common (43.5% in residents with no/mild cognitive impairment), but less so in those with severe cognitive impairment (20.1%). Documentation of facial expressions and nonverbal pain behaviors was more frequent for residents with moderate and severe cognitive impairment than those with no/mild cognitive impairment. CONCLUSIONS The prevalence of behaviors indicative of pain differs by level of cognitive impairment. Pain evaluation and management plays an important role in treatment and care outcomes. Future work should examine how practitioners' perceptions of pain behaviors influence their ratings of pain intensity and treatment choices.
Collapse
Affiliation(s)
- Reynolds A Morrison
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Bill M Jesdale
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Catherine E Dubé
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Anthony P Nunes
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Carol A Bova
- School of Nursing, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Shao-Hsien Liu
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA,
| |
Collapse
|
26
|
Zahid M, Gallant NL, Hadjistavropoulos T, Stroulia E. Behavioral Pain Assessment Implementation in Long-Term Care Using a Tablet App: Case Series and Quasi-Experimental Design. JMIR Mhealth Uhealth 2020; 8:e17108. [PMID: 32319955 PMCID: PMC7203621 DOI: 10.2196/17108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/05/2020] [Accepted: 02/10/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Pain is often underassessed and undertreated among long-term care (LTC) residents living with dementia. When used regularly, the Pain Assessment Checklist for Seniors With Limited Ability to Communicate (PACSLAC) scales have been shown to have beneficial effects on pain assessment and management practices and stress and burnout levels in frontline staff in LTC facilities. Such scales, however, are not utilized as often as recommended, which is likely to be related to additional record-keeping and tracking over time involved with their paper-and-pencil administration. OBJECTIVE Using implementation science principles, we assessed the introduction of the PACSLAC-II scale by comparing two methods of administration-a newly developed tablet app version and the original paper-and-pencil version-with respect to the frequency of pain assessment and facility staff feedback. METHODS Using a case series approach, we tracked pain-related quality indicators at baseline, implementation, and follow-up periods. A quasi-experimental design was used to evaluate the effect of the method of administration (ie, paper-and-pencil only [n=18], tablet only [n=12], paper-and-pencil followed by tablet app [n=31], and tablet app followed by paper-and-pencil [n=31]) on pain assessment frequency and frontline staff stress and burnout levels. Finally, semistructured interviews were conducted with frontline staff to obtain perspectives on each method of administration. RESULTS The implementation effort resulted in a great increase in pain assessment frequency across 7 independent LTC units, although these increases were not maintained during the follow-up period. Frontline staff reported lower levels of workload in the paper-and-pencil followed by tablet app condition than those in the paper-and-pencil only (P<.001) and tablet app followed by paper-and-pencil (P<.001) conditions. Frontline staff also reported lower levels of workload in the tablet-only condition than those in the paper-and-pencil only condition (P=.05). Similarly, lower levels of emotional exhaustion were reported by frontline staff in the paper-and-pencil followed by tablet app condition than those in the paper-and-pencil only (P=.002) and tablet app followed by paper-and-pencil (P=.002) conditions. Finally, frontline staff reported higher levels of depersonalization in the paper-and-pencil only condition than those in the tablet app only (P=.008), paper-and-pencil followed by tablet app (P<.001), and tablet app followed by paper-and-pencil (P<.001) conditions. Furthermore, narrative data from individual interviews with frontline staff revealed a preference for the tablet app over the paper-and-pencil method of administration. CONCLUSIONS This study provides support for the use of either the tablet app or the paper-and-pencil version of the PACSLAC-II to improve pain-related quality indicators, but a reported preference for and lower levels of stress and burnout with the use of the tablet app method of administration suggests that the use of the tablet app may have more advantages compared with the paper-and-pencil method of administration.
Collapse
Affiliation(s)
- Mahnoor Zahid
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Natasha L Gallant
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Eleni Stroulia
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
27
|
Pergolizzi JV, Raffa RB, Paladini A, Varrasi G, LeQuang JA. Treating pain in patients with dementia and the possible concomitant relief of symptoms of agitation. Pain Manag 2019; 9:569-582. [DOI: 10.2217/pmt-2019-0024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Dementia is an irreversible, progressive form of cognitive dysfunction that can affect memory, learning ability, thinking, orientation, comprehension, calculation, linguistic skills and executive function but which does not impair consciousness. Pain prevalence is high among the elderly who are also at elevated risk for dementia. Pain control for dementia patients is important but can be challenging for clinicians as cognitive deficits can make it difficult to identify, localize and assess pain. Cerebral changes associated with dementia may change how people process and experience pain in ways that are not entirely elucidated. Agitation is a frequent symptom of dementia and may be associated with untreated pain as agitation and aggression symptoms decrease when pain is effectively addressed.
Collapse
Affiliation(s)
| | - Robert B Raffa
- University of Arizona, Department of Pharmacy, Tucson, AZ 85721, USA
| | | | | | | |
Collapse
|
28
|
Abstract
Facial expressions of pain are not undefined grimaces, but they convey specific information about the internal state of the individual in pain. With this systematic review, we aim to answer the question of which facial movements are displayed most consistently during pain. We searched for studies that used the Facial Action Coding System to analyze facial activity during pain in adults, and that report on distinct facial responses (action units [AUs]). Twenty-seven studies using experimental pain and 10 clinical pain studies were included. We synthesized the data by taking into consideration (1) the criteria used to define whether an AU is pain-related; (2) types of pain; and (3) the cognitive status of the individuals. When AUs were selected as being pain-related based on a "pain > baseline" increase, a consistent subset of pain-related AUs emerged across studies: lowering the brows (AU4), cheek raise/lid tightening (AUs6_7), nose wrinkling/raising the upper lip (AUs9_10), and opening of the mouth (AUs25_26_27). This subset was found independently of the cognitive status of the individuals and was stable across clinical and experimental pain with only one variation, namely that eye closure (AU43) occurred more frequently during clinical pain. This subset of pain-related facial responses seems to encode the essential information about pain available in the face. However, given that these pain-related AUs are most often not displayed all at once, but are differently combined, health care professionals should use a more individualized approach, determining which pain-related facial responses an individual combines and aggregates to express pain, instead of erroneously searching for a uniform expression of pain.
Collapse
|
29
|
Gagliese L, Gauthier LR, Narain N, Freedman T. Pain, aging and dementia: Towards a biopsychosocial model. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:207-215. [PMID: 28947182 DOI: 10.1016/j.pnpbp.2017.09.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 12/30/2022]
Abstract
Dementia is a progressive disease associated with irreversible impairment and loss of cognitive abilities. About half of older people with dementia experience pain. In this paper, we propose that pain in older people with dementia can be conceptualized as the final result of the interaction of three heterogeneous phenomena, pain, aging, and dementia, which are created and influenced by the interactions of predisposing, lifelong, and current biopsychosocial factors. We review pain assessment in people with dementia using both self-report and observational/behavioral measures. We then review the biological/sensory, psychological (cognitive and affective) and social dimensions of pain in dementia. The available data suggest that dementia does not impact pain threshold or tolerance. To date, there is little research on the social dimension of pain in dementia. Changes in the affective domain in response to experimental pain have been contradictory with evidence supporting both increased and decreased unpleasantness and emotional responsiveness in people with dementia compared to healthy controls. Clinically, depression is a significant burden for older people with dementia and chronic pain. The relationship between pain and other neuropsychiatric symptoms is controversial, and there is insufficient evidence on which to base conclusions. Some of the most important dementia-related changes may arise in the cognitive domain, including impairments of semantic and episodic memory for pain, executive function, and pain anticipation. Changes in brain activation and interconnectivity support many of these conclusions. Despite methodological limitations, we conclude there are compelling preliminary data to support a biopsychosocial framework of pain and dementia. Future research directions, especially the need for improved assessment tools, are highlighted.
Collapse
Affiliation(s)
- Lucia Gagliese
- School of Kinesiology and Health Science, York University, 4700 Keele St., Toronto M3J 1P3, Canada; Department of Anesthesia & Pain Management, Toronto General Hospital, Canada; Department of Supportive Care, Princess Margaret Cancer Centre, Canada; Campbell Family Cancer Research Institute, Ontario Cancer Institute, University Health Network, 200 Elizabeth St., Toronto M5G 2C5, Canada; Department of Anesthesia, Mount Sinai Hospital, 600 University Ave, Toronto M5G 1X5, Canada; Faculty of Medicine, University of Toronto, 1 King's College Cir #3172, Toronto M5S 1A8, Canada; Department of Psychiatry, Toronto General Hospital, Canada.
| | - Lynn R Gauthier
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Québec G1V 0A6, Canada; l'Équipe de recherche Michel-Sarrazin en oncologie psychosociale et soins palliatifs, Canada; CHU de Québec-Université Laval Research Center, Oncology Research Axis, Canada; Université Laval Cancer Research Center, 9 Rue McMahon, Québec G1R 3S3, Canada
| | - Nadine Narain
- Department of Anesthesia & Pain Management, Toronto General Hospital, Canada
| | - Tamlyn Freedman
- Department of Anesthesia & Pain Management, Toronto General Hospital, Canada
| |
Collapse
|
30
|
Atee M, Hoti K, Parsons R, Hughes JD. A novel pain assessment tool incorporating automated facial analysis: interrater reliability in advanced dementia. Clin Interv Aging 2018; 13:1245-1258. [PMID: 30038491 PMCID: PMC6052926 DOI: 10.2147/cia.s168024] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Regardless of its severity, dementia does not negate the experience of pain. Rather, dementia hinders self-reporting mechanisms in affected individuals because they lose the ability to do so. The primary aim of this study was to examine the interrater reliability of the electronic Pain Assessment Tool (ePAT) among raters when assessing pain in residents with moderate-to-severe dementia. Secondly, it sought to examine the relationship between total instrument scores and facial scores, as determined by automated facial expression analysis. STUDY DESIGN A 2-week observational study. SETTING An accredited, high-care, and dementia-specific residential aged care facility in Perth, Western Australia. PARTICIPANTS Subjects were 10 residents (age range: 63.1-84.4 years old) predominantly with severe dementia (Dementia Severity Rating Scale score: 46.3±8.4) rated for pain by 11 aged care staff. Raters (female: 82%; mean age: 44.1±12.6 years) consisted of one clinical nurse, four registered nurses, five enrolled nurses, and one care worker. MEASUREMENTS ePAT measured pain using automated detection of facial action codes and recordings of pain behaviors. RESULTS A total of 76 assessments (rest =38 [n=19 pairs], movement =38 [n=19 pairs]) were conducted. At rest, raters' agreement was excellent on overall total scores (coefficient of concordance =0.92 [95% CI: 0.85-0.96]) and broad category scores (κ=1.0). Agreement was moderate (κ=0.59) on categorical scores upon movement, while it was exact in 68.4% of the cases. Agreement in actual pain category scores gave κw=0.72 (95% CI: 0.58-0.86) at rest and κw=0.69 (95% CI: 0.50-0.87) with movement. All raters scored residents with higher total scores post-mobilization compared to rest. More facial action unit codes were also detected during pain (mean: 2.5 vs 1.9; p<0.0012) and following mobilization (mean: 2.5 vs 1.7; p<0.0001) compared to no pain and rest, respectively. CONCLUSIONS ePAT, which combines automated facial expression analysis and clinical behavioral indicators in a single observational pain assessment tool, demonstrates good reliability properties, which supports its appropriateness for use in residents with advanced dementia.
Collapse
Affiliation(s)
- Mustafa Atee
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia,
| | - Kreshnik Hoti
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia,
- Division of Pharmacy, Faculty of Medicine, University of Pristina, Prishtina, Kosovo
| | - Richard Parsons
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia,
| | - Jeffery D Hughes
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia,
| |
Collapse
|
31
|
Dubé CE, Mack DS, Hunnicutt JN, Lapane KL. Cognitive Impairment and Pain Among Nursing Home Residents With Cancer. J Pain Symptom Manage 2018; 55:1509-1518. [PMID: 29496536 PMCID: PMC5951760 DOI: 10.1016/j.jpainsymman.2018.02.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/13/2018] [Accepted: 02/13/2018] [Indexed: 11/15/2022]
Abstract
CONTEXT The prevalence of pain and its management has been shown to be inversely associated with greater levels of cognitive impairment. OBJECTIVES To evaluate whether the documentation and management of pain varies by level of cognitive impairment among nursing home residents with cancer. METHODS Using a cross-sectional study, we identified all newly admitted U.S. nursing home residents with a cancer diagnosis in 2011-2012 (n = 367,462). Minimum Data Set 3.0 admission assessment was used to evaluate pain/pain management in the past five days and cognitive impairment (assessed via the Brief Interview for Mental Status or the Cognitive Performance Scale for 91.6% and 8.4%, respectively). Adjusted prevalence ratios with 95% CI were estimated from robust Poisson regression models. RESULTS For those with staff-assessed pain, pain prevalence was 55.5% with no/mild cognitive impairment and 50.5% in those severely impaired. Pain was common in those able to self-report (67.9% no/mild, 55.9% moderate, and 41.8% severe cognitive impairment). Greater cognitive impairment was associated with reduced prevalence of any pain (adjusted prevalence ratio severe vs. no/mild cognitive impairment; self-assessed pain 0.77; 95% CI 0.76-0.78; staff-assessed pain 0.96; 95% CI 0.93-0.99). Pharmacologic pain management was less prevalent in those with severe cognitive impairment (59.4% vs. 74.9% in those with no/mild cognitive impairment). CONCLUSION In nursing home residents with cancer, pain was less frequently documented in those with severe cognitive impairment, which may lead to less frequent use of treatments for pain. Techniques to improve documentation and treatment of pain in nursing home residents with cognitive impairment are needed.
Collapse
Affiliation(s)
- Catherine E Dubé
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
| | - Deborah S Mack
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jacob N Hunnicutt
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| |
Collapse
|
32
|
Rouch I, Pongan E, Leveque Y, Tillmann B, Trombert B, Getenet JC, Auguste N, Krolak-Salmon P, Laurent B, Dorey JM. Personality Modulates the Efficacy of Art Intervention on Chronic Pain in a Population of Patients with Alzheimer’s Disease. J Alzheimers Dis 2018; 63:617-624. [DOI: 10.3233/jad-170990] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Isabelle Rouch
- Memory Clinical and Research Center of Saint Etienne (CMRR) Neurology Unit, University Hospital of Saint Etienne, Saint Etienne, France
- Memory Clinical and Research Center of Lyon (CMRR), Hospital of Charpennes, University Hospital of Lyon, France
- Institute of Aging I-Vie, University Hospital of Lyon, France
| | - Elodie Pongan
- Memory Clinical and Research Center of Saint Etienne (CMRR) Neurology Unit, University Hospital of Saint Etienne, Saint Etienne, France
- Memory Clinical and Research Center of Lyon (CMRR), Hospital of Charpennes, University Hospital of Lyon, France
- Institute of Aging I-Vie, University Hospital of Lyon, France
| | - Yohana Leveque
- INSERM, U1028, CNRS, UMR5292, University Lyon 1, Lyon Neuroscience Research Center, Psychoacoustic and Auditory Cognition team, Lyon, France
| | - Barbara Tillmann
- INSERM, U1028, CNRS, UMR5292, University Lyon 1, Lyon Neuroscience Research Center, Psychoacoustic and Auditory Cognition team, Lyon, France
| | - Béatrice Trombert
- Public Health and Medical Information Unit, University Hospital of Saint-Etienne, Saint Etienne, France
| | - Jean Claude Getenet
- Memory Clinical and Research Center of Saint Etienne (CMRR) Neurology Unit, University Hospital of Saint Etienne, Saint Etienne, France
| | - Nicolas Auguste
- Memory Clinical and Research Center of Saint Etienne (CMRR) Geriatrics Unit, University Hospital of Saint Etienne, Saint Etienne, France
| | - Pierre Krolak-Salmon
- Memory Clinical and Research Center of Lyon (CMRR), Hospital of Charpennes, University Hospital of Lyon, France
- Institute of Aging I-Vie, University Hospital of Lyon, France
- Brain Dynamics and Cognition, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Lyon, France
| | - Bernard Laurent
- Memory Clinical and Research Center of Saint Etienne (CMRR) Neurology Unit, University Hospital of Saint Etienne, Saint Etienne, France
- INSERM, U1028, CNRS, UMR5292, Neuropain team, Lyon Neuroscience Research Center, Lyon, France
| | - Jean-Michel Dorey
- Brain Dynamics and Cognition, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Lyon, France
- Department of Psychiatry, Hospital Le Vinatier, Bron, France
| | | |
Collapse
|
33
|
Lautenbacher S, Walz AL, Kunz M. Using observational facial descriptors to infer pain in persons with and without dementia. BMC Geriatr 2018; 18:88. [PMID: 29642850 PMCID: PMC5896123 DOI: 10.1186/s12877-018-0773-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 03/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background For patients with advanced dementia, pain diagnosis and assessment requires observations of pain-indicative behavior by others. One type of behavior that has been shown to be a promising candidate is the facial response to pain. To further test how pain-indicative facial responses are, we investigated the predictive power of observational facial descriptors to (i) predict the self-report of pain and (ii) to differentiate between non-painful and painful conditions. In addition, the expertise of the observers (nurses vs. healthy controls) and the cognitive status of the observed (dementia vs. cognitively healthy) were considered. Methods Overall 62 participants (32 nurses and 30 control subjects) watched 40 video-clips, showing facial expressions of older individuals with and without dementia during non-painful and painful pressure stimulation. After each clip, participants were asked to rate the videos using commonly used facial descriptors of pain and also to provide global pain estimate ratings of how much pain the observed individual might have experienced. Results Out of the 12 facial descriptors used, only 7 were able to differentiate between non-painful and painful conditions. Moreover, participants were better in predicting the pain self-report of the observed individuals when using facial descriptors than when using global pain estimates. Especially, the anatomically-orienting descriptors (e.g. opened mouth, narrowing eyes) showed greatest predictive power. Results were not affected by pain-expertise of the observers (nurses vs. control subjects) or diagnostic status of the observed (patients with dementia vs. cognitively unimpaired subjects). Conclusions The fine-grained and specific observation of facial responses to acute pain appeared to provide valid indication of pain that is not compromised when patients with dementia are observed. The regular professional training does not put nurses at advantage to detect pain via facial responses.
Collapse
Affiliation(s)
- Stefan Lautenbacher
- Physiological Psychology, University of Bamberg, Markuspl. 3, 96045, Bamberg, Germany.
| | - Anna Lena Walz
- Physiological Psychology, University of Bamberg, Markuspl. 3, 96045, Bamberg, Germany
| | - Miriam Kunz
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
34
|
van Dalen-Kok AH, Achterberg WP, Rijkmans WE, Tukker-van Vuuren SA, Delwel S, de Vet HC, Lobbezoo F, de Waal MW. Pain Assessment in Impaired Cognition (PAIC): content validity of the Dutch version of a new and universal tool to measure pain in dementia. Clin Interv Aging 2017; 13:25-34. [PMID: 29317807 PMCID: PMC5743184 DOI: 10.2147/cia.s144651] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives Detection and measurement of pain in persons with dementia by using observational pain measurement tools is essential. However, the evidence for the psychometric properties of existing observational tools remains limited. Therefore, a new meta-tool has been developed: Pain Assessment in Impaired Cognition (PAIC), as a collaborative EU action. The aim is to describe the translation procedure and content validity of the Dutch version of the PAIC. Methods Translation of the PAIC into Dutch followed the forward-backward approach of the Guidelines for Establishing Cultural Equivalence of Instruments. A questionnaire survey was administered to clinical nursing home experts (20 physicians and 20 nurses) to determine whether the PAIC items are indicative of pain and whether items are specific for pain or for other disorders (anxiety disorder, delirium, dementia, or depression). To quantify content validity, mean scores per item were calculated. Results Eleven items were indicative of pain, for example, “frowning,” “freezing,” and “groaning.” Fifteen items were considered to be pain-specific, for example, “frowning,” “curling up,” and “complaining.” There were discrepancies between the notion of pain characteristics according to nurses and physicians, especially in the facial expressions domain. Discussion Within the body movement domain, PAIC items correspond well with the clinical experience of the physicians and nurses. However, items in the facial expressions and vocalizations domains need further study with respect to item reduction. Also, differences were revealed in the notion of pain characteristics between physicians and nurses, suggesting the need for more interdisciplinary education on pain in dementia.
Collapse
Affiliation(s)
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden
| | - Wieke E Rijkmans
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden
| | | | - Suzanne Delwel
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam.,Department of Clinical Neuropsychology, Faculty of Behavioral and Movement Sciences, VU University
| | - Henrica Cw de Vet
- Department of Epidemiology and Biostatistics, The EMGO Institute for Health and Care Research, VU University Medical Center
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam.,MOVE Research Institute Amsterdam, VU University, Amsterdam, the Netherlands
| | - Margot Wm de Waal
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden
| |
Collapse
|
35
|
Ruest M, Bourque M, Laroche S, Harvey MP, Martel M, Bergeron-Vézina K, Apinis C, Proulx D, Hadjistavropoulos T, Tousignant-Laflamme Y, Léonard G. Can We Quickly and Thoroughly Assess Pain with the PACSLAC-II? A Convergent Validity Study in Long-Term Care Residents Suffering from Dementia. Pain Manag Nurs 2017; 18:410-417. [DOI: 10.1016/j.pmn.2017.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 05/31/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
|
36
|
Pongan E, Tillmann B, Leveque Y, Trombert B, Getenet JC, Auguste N, Dauphinot V, El Haouari H, Navez M, Dorey JM, Krolak-Salmon P, Laurent B, Rouch I. Can Musical or Painting Interventions Improve Chronic Pain, Mood, Quality of Life, and Cognition in Patients with Mild Alzheimer’s Disease? Evidence from a Randomized Controlled Trial. J Alzheimers Dis 2017; 60:663-677. [DOI: 10.3233/jad-170410] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Elodie Pongan
- Memory Clinical and Research Center of Saint Etienne (CMRR) Neurology Unit, University Hospital of Saint Etienne, Saint Etienne, France
- Memory Clinical and Research Center of Lyon (CMRR), Hospital of Charpennes, University Hospital of Lyon, France
- Institute of Aging I-Vie, University Hospital of Lyon, France
| | - Barbara Tillmann
- INSERM, U1028; CNRS, UMR5292; Psychoacoustic and Auditory Cognition team, Lyon Neuroscience Research Center, Lyon, France
| | - Yohana Leveque
- INSERM, U1028; CNRS, UMR5292; Psychoacoustic and Auditory Cognition team, Lyon Neuroscience Research Center, Lyon, France
| | - Béatrice Trombert
- Public Health and Medical Information Unit, University Hospital of Saint-Etienne, Saint Etienne, France
| | - Jean Claude Getenet
- Memory Clinical and Research Center of Saint Etienne (CMRR) Neurology Unit, University Hospital of Saint Etienne, Saint Etienne, France
| | - Nicolas Auguste
- Memory Clinical and Research Center of Saint Etienne (CMRR) Geriatrics Unit, University Hospital of Saint Etienne, Saint Etienne, France
| | - Virginie Dauphinot
- Memory Clinical and Research Center of Lyon (CMRR), Hospital of Charpennes, University Hospital of Lyon, France
- Institute of Aging I-Vie, University Hospital of Lyon, France
| | - Hanane El Haouari
- Memory Clinical and Research Center of Saint Etienne (CMRR) Neurology Unit, University Hospital of Saint Etienne, Saint Etienne, France
| | - Malou Navez
- Memory Clinical and Research Center of Saint Etienne (CMRR) Neurology Unit, University Hospital of Saint Etienne, Saint Etienne, France
| | | | - Pierre Krolak-Salmon
- Memory Clinical and Research Center of Lyon (CMRR), Hospital of Charpennes, University Hospital of Lyon, France
- Institute of Aging I-Vie, University Hospital of Lyon, France
| | - Bernard Laurent
- Memory Clinical and Research Center of Saint Etienne (CMRR) Neurology Unit, University Hospital of Saint Etienne, Saint Etienne, France
- INSERM, U1028; CNRS, UMR5292; Neuropain team, Lyon Neuroscience Research Center, Lyon, France
| | - Isabelle Rouch
- Memory Clinical and Research Center of Saint Etienne (CMRR) Neurology Unit, University Hospital of Saint Etienne, Saint Etienne, France
- Memory Clinical and Research Center of Lyon (CMRR), Hospital of Charpennes, University Hospital of Lyon, France
- Institute of Aging I-Vie, University Hospital of Lyon, France
| | | |
Collapse
|
37
|
Beach PA, Huck JT, Zhu DC, Bozoki AC. Altered Behavioral and Autonomic Pain Responses in Alzheimer's Disease Are Associated with Dysfunctional Affective, Self-Reflective and Salience Network Resting-State Connectivity. Front Aging Neurosci 2017; 9:297. [PMID: 28959201 PMCID: PMC5603705 DOI: 10.3389/fnagi.2017.00297] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 08/30/2017] [Indexed: 12/25/2022] Open
Abstract
While pain behaviors are increased in Alzheimer's disease (AD) patients compared to healthy seniors (HS) across multiple disease stages, autonomic responses are reduced with advancing AD. To better understand the neural mechanisms underlying these phenomena, we undertook a controlled cross-sectional study examining behavioral (Pain Assessment in Advanced Dementia, PAINAD scores) and autonomic (heart rate, HR) pain responses in 24 HS and 20 AD subjects using acute pressure stimuli. Resting-state fMRI was utilized to investigate how group connectivity differences were related to altered pain responses. Pain behaviors (slope of PAINAD score change and mean PAINAD score) were increased in patients vs. CONTROLS Autonomic measures (HR change intercept and mean HR change) were reduced in severe vs. mildly affected AD patients. Group functional connectivity differences associated with greater pain behavior reactivity in patients included: connectivity within a temporal limbic network (TLN) and between the TLN and ventromedial prefrontal cortex (vmPFC); between default mode network (DMN) subcomponents; between the DMN and ventral salience network (vSN). Reduced HR responses within the AD group were associated with connectivity changes within the DMN and vSN-specifically the precuneus and vmPFC. Discriminant classification indicated HR-related connectivity within the vSN to the vmPFC best distinguished AD severity. Thus, altered behavioral and autonomic pain responses in AD reflects dysfunction of networks and structures subserving affective, self-reflective, salience and autonomic regulation.
Collapse
Affiliation(s)
- Paul A Beach
- D.O., Ph.D. Training Program, Michigan State University College of Osteopathic MedicineEast Lansing, MI, United States.,Neuroscience Program, Michigan State UniversityEast Lansing, MI, United States
| | - Jonathan T Huck
- Neuroscience Program, Michigan State UniversityEast Lansing, MI, United States
| | - David C Zhu
- Neuroscience Program, Michigan State UniversityEast Lansing, MI, United States.,Department of Radiology, Michigan State UniversityEast Lansing, MI, United States.,Department of Psychology, Michigan State UniversityEast Lansing, MI, United States
| | - Andrea C Bozoki
- Neuroscience Program, Michigan State UniversityEast Lansing, MI, United States.,Department of Neurology & Ophthalmology, Michigan State UniversityEast Lansing, MI, United States
| |
Collapse
|
38
|
Jones J, Sim TF, Hughes J. Pain Assessment of Elderly Patients with Cognitive Impairment in the Emergency Department: Implications for Pain Management-A Narrative Review of Current Practices. PHARMACY 2017; 5:E30. [PMID: 28970442 PMCID: PMC5597155 DOI: 10.3390/pharmacy5020030] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/05/2017] [Accepted: 05/26/2017] [Indexed: 01/08/2023] Open
Abstract
Elderly people are susceptible to both falls and cognitive impairment making them a particularly vulnerable group of patients when it comes to pain assessment and management in the emergency department (ED). Pain assessment is often difficult in patients who present to the ED with a cognitive impairment as they are frequently unable to self-report their level of pain, which can have a negative impact on pain management. This paper aims to review how cognitive impairment influences pain assessment in elderly adults who present to the ED with an injury due to a fall. A literature search of EMBASE, ProQuest, PubMed, Science Direct, SciFinder and the Curtin University Library database was conducted using keyword searches to generate lists of articles which were then screened for relevance by title and then abstract to give a final list of articles for full-text review. Further articles were identified by snowballing from the reference lists of the full-text articles. The literature reports that ED staff commonly use visual or verbal analogue scales to assess pain, but resort to their own intuition or physiological parameters rather than using standardised observational pain assessment tools when self-report of pain is not attainable due to cognitive impairment. While studies have found that the use of pain assessment tools improves the recognition and management of pain, pain scores are often not recorded for elderly patients with a cognitive impairment in the ED, leading to poorer pain management in this patient group in terms of time to analgesic administration and the use of strong opioids. All healthcare professionals involved in the care of such patients, including pharmacists, need to be aware of this and strive to ensure analgesic use is guided by appropriate and accurate pain assessment in the ED.
Collapse
Affiliation(s)
- Joshua Jones
- School of Pharmacy, Curtin University, Western Australia 6102, Australia.
| | - Tin Fei Sim
- School of Pharmacy, Curtin University, Western Australia 6102, Australia.
| | - Jeff Hughes
- School of Pharmacy, Curtin University, Western Australia 6102, Australia.
| |
Collapse
|
39
|
Wong AYL, Karppinen J, Samartzis D. Low back pain in older adults: risk factors, management options and future directions. SCOLIOSIS AND SPINAL DISORDERS 2017; 12:14. [PMID: 28435906 PMCID: PMC5395891 DOI: 10.1186/s13013-017-0121-3] [Citation(s) in RCA: 205] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/04/2017] [Indexed: 12/12/2022]
Abstract
Low back pain (LBP) is one of the major disabling health conditions among older adults aged 60 years or older. While most causes of LBP among older adults are non-specific and self-limiting, seniors are prone to develop certain LBP pathologies and/or chronic LBP given their age-related physical and psychosocial changes. Unfortunately, no review has previously summarized/discussed various factors that may affect the effective LBP management among older adults. Accordingly, the objectives of the current narrative review were to comprehensively summarize common causes and risk factors (modifiable and non-modifiable) of developing severe/chronic LBP in older adults, to highlight specific issues in assessing and treating seniors with LBP, and to discuss future research directions. Existing evidence suggests that prevalence rates of severe and chronic LBP increase with older age. As compared to working-age adults, older adults are more likely to develop certain LBP pathologies (e.g., osteoporotic vertebral fractures, tumors, spinal infection, and lumbar spinal stenosis). Importantly, various age-related physical, psychological, and mental changes (e.g., spinal degeneration, comorbidities, physical inactivity, age-related changes in central pain processing, and dementia), as well as multiple risk factors (e.g., genetic, gender, and ethnicity), may affect the prognosis and management of LBP in older adults. Collectively, by understanding the impacts of various factors on the assessment and treatment of older adults with LBP, both clinicians and researchers can work toward the direction of more cost-effective and personalized LBP management for older people.
Collapse
Affiliation(s)
- Arnold YL Wong
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR China
| | - Jaro Karppinen
- Medical Research Center Oulu, Department of Physical and Rehabilitation Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland
- Finnish Institute of Occupational Health, Oulu, Finland
| | - Dino Samartzis
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, SAR China
| |
Collapse
|
40
|
Blattner CM, Markus B, Lear W. Preventing disruption of surgical dressings in patients with cognitive impairment. J Am Acad Dermatol 2017; 76:e173-e174. [PMID: 28411791 DOI: 10.1016/j.jaad.2016.11.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 11/06/2016] [Accepted: 11/28/2016] [Indexed: 11/16/2022]
Affiliation(s)
| | - Brandon Markus
- Department of Dermatology and Dermatologic Surgery, Silver Falls Dermatology, Salem, Oregon
| | - William Lear
- Department of Dermatology and Dermatologic Surgery, Silver Falls Dermatology, Salem, Oregon
| |
Collapse
|
41
|
Cornelius R, Herr KA, Gordon DB, Kretzer K, Butcher HK. Evidence-Based Practice Guideline : Acute Pain Management in Older Adults. J Gerontol Nurs 2017; 43:18-27. [DOI: 10.3928/00989134-20170111-08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
42
|
Lautenbacher S, Peters JH, Heesen M, Scheel J, Kunz M. Age changes in pain perception: A systematic-review and meta-analysis of age effects on pain and tolerance thresholds. Neurosci Biobehav Rev 2017; 75:104-113. [PMID: 28159611 DOI: 10.1016/j.neubiorev.2017.01.039] [Citation(s) in RCA: 245] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 11/25/2016] [Accepted: 01/27/2017] [Indexed: 01/01/2023]
Abstract
Demographic changes, with substantial increase in life expectancy, ask for solid knowledge about how pain perception might be altered by aging. Although psychophysical studies on age-related changes in pain perception have been conducted over more than 70 years, meta-analyses are still missing. The present meta-analysis aimed to quantify evidence on age-related changes in pain perception, indexed by pain thresholds and pain tolerance thresholds in young and older healthy adults. After searching PubMed, Google Scholar and PsycINFO using state-of-art screening (PRISMA-criteria), 31 studies on pain threshold and 9 studies assessing pain tolerance threshold were identified. Pain threshold increases with age, which is indicated by a large effect size. This age-related change increases the wider the age-gap between groups; and is especially prominent when heat is used and when stimuli are applied to the head. In contrast, pain tolerance thresholds did not show substantial age-related changes. Thus, after many years of investigating age-related changes in pain perception, we only have firm evidence that aging reduces pain sensitivity for lower pain intensities.
Collapse
Affiliation(s)
| | - Jan H Peters
- Department of Educational Psychology and Psychological Assessment, University of Bamberg, Bamberg, Germany
| | - Michael Heesen
- Department of Anaesthesia, Kantonsspital Baden, Baden, Switzerland
| | - Jennifer Scheel
- Physiological Psychology, University of Bamberg, Bamberg, Germany
| | - Miriam Kunz
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, The Netherlands
| |
Collapse
|
43
|
Boura E, Stamelou M, Vadasz D, Ries V, Unger MM, Kägi G, Oertel WH, Möller JC, Mylius V. Is increased spinal nociception another hallmark for Parkinson's disease? J Neurol 2017; 264:570-575. [PMID: 28120040 DOI: 10.1007/s00415-016-8390-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 01/25/2023]
Abstract
Augmented spinal nociception during the "off" phase has been observed early in Parkinson's disease further increasing with disease duration. To find out whether increased spinal nociception represents a premotor feature, experimental pain sensitivity was assessed in idiopathic REM-sleep behavior disorder (IRBD) patients with or without signs of a neurodegenerative disorder compared to early Parkinson's disease (ePD) patients and healthy controls (HC). Spinal nociception as measured by the nociceptive flexion reflex (NFR) and experimental pain sensitivity as measured by heat and electrical pain thresholds were determined in 14 IRBD, 15 ePD patients in the medication-defined "off" state and 27 HC in an explorative cohort study. No significant differences between IRBD and HC were found with regard to spinal nociception (NFR) and experimental pain sensitivity. However, IRBD patient with anosmia and/or abnormal DaTSCAN tended to increased experimental pain sensitivity. In contrast, early PD patients exhibited increased NFR responses compared to HC, and a tendency for increased spinal nociception compared to IRBD patients. Increased spinal nociception may represent an early but not a premotor, non-motor feature of PD. Whether increased pain sensitivity already presents a premotor feature should be assessed in further studies.
Collapse
Affiliation(s)
- Evangelia Boura
- Department of Neurology, Philipps University, Baldingerstrasse, 35043, Marburg, Germany
| | - Maria Stamelou
- Department of Neurology, Philipps University, Baldingerstrasse, 35043, Marburg, Germany.,Second Department of Neurology, Movement Disorders Clinic, University of Athens and Movement Disorders Department, Hygeia Hospital, Athens, Greece
| | - David Vadasz
- Department of Neurology, Philipps University, Baldingerstrasse, 35043, Marburg, Germany
| | - Vincent Ries
- Department of Neurology, Philipps University, Baldingerstrasse, 35043, Marburg, Germany
| | - Marcus M Unger
- Department of Neurology, Philipps University, Baldingerstrasse, 35043, Marburg, Germany.,Department of Neurology, Saarland University, Homburg, Germany
| | - Georg Kägi
- Department of Neurology, Kantonsspital St.Gallen, St. Gallen, Switzerland
| | - Wolfgang H Oertel
- Department of Neurology, Philipps University, Baldingerstrasse, 35043, Marburg, Germany
| | - Jens C Möller
- Department of Neurology, Philipps University, Baldingerstrasse, 35043, Marburg, Germany.,Parkinson Center, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Veit Mylius
- Department of Neurology, Philipps University, Baldingerstrasse, 35043, Marburg, Germany. .,Department of Neurology, Kantonsspital St.Gallen, St. Gallen, Switzerland. .,Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland.
| |
Collapse
|
44
|
Kunz M, Seuss D, Hassan T, Garbas JU, Siebers M, Schmid U, Schöberl M, Lautenbacher S. Problems of video-based pain detection in patients with dementia: a road map to an interdisciplinary solution. BMC Geriatr 2017; 17:33. [PMID: 28125956 PMCID: PMC5270300 DOI: 10.1186/s12877-017-0427-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 01/19/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Given the unreliable self-report in patients with dementia, pain assessment should also rely on the observation of pain behaviors, such as facial expressions. Ideal observers should be well trained and should observe the patient continuously in order to pick up any pain-indicative behavior; which are requisitions beyond realistic possibilities of pain care. Therefore, the need for video-based pain detection systems has been repeatedly voiced. Such systems would allow for constant monitoring of pain behaviors and thereby allow for a timely adjustment of pain management in these fragile patients, who are often undertreated for pain. METHODS In this road map paper we describe an interdisciplinary approach to develop such a video-based pain detection system. The development starts with the selection of appropriate video material of people in pain as well as the development of technical methods to capture their faces. Furthermore, single facial motions are automatically extracted according to an international coding system. Computer algorithms are trained to detect the combination and timing of those motions, which are pain-indicative. RESULTS/CONCLUSION We hope to encourage colleagues to join forces and to inform end-users about an imminent solution of a pressing pain-care problem. For the near future, implementation of such systems can be foreseen to monitor immobile patients in intensive and postoperative care situations.
Collapse
Affiliation(s)
- Miriam Kunz
- Physiological Psychology, Otto-Friedrich University Bamberg, Bamberg, Germany.
- Department of General Practice, Section Gerontology, University of Groningen, University Medical Center Groningen, PO Box 196 (HPC FA21), 9700 AD, Groningen, The Netherlands.
| | - Dominik Seuss
- Fraunhofer Institute for Integrated Circuits IIS, Erlangen, Germany
- Cognitive Systems Group, Faculty Information Systems and Applied Computer Science, Otto-Friedrich University Bamberg, Bamberg, Germany
| | - Teena Hassan
- Fraunhofer Institute for Integrated Circuits IIS, Erlangen, Germany
| | - Jens U Garbas
- Fraunhofer Institute for Integrated Circuits IIS, Erlangen, Germany
| | - Michael Siebers
- Cognitive Systems Group, Faculty Information Systems and Applied Computer Science, Otto-Friedrich University Bamberg, Bamberg, Germany
| | - Ute Schmid
- Cognitive Systems Group, Faculty Information Systems and Applied Computer Science, Otto-Friedrich University Bamberg, Bamberg, Germany
| | - Michael Schöberl
- Fraunhofer Institute for Integrated Circuits IIS, Erlangen, Germany
| | - Stefan Lautenbacher
- Physiological Psychology, Otto-Friedrich University Bamberg, Bamberg, Germany
| |
Collapse
|
45
|
Monroe TB, Beach PA, Bruehl SP, Dietrich MS, Rogers BP, Gore JC, Atalla SW, Cowan RL. The Impact of Alzheimer's Disease on the Resting State Functional Connectivity of Brain Regions Modulating Pain: A Cross Sectional Study. J Alzheimers Dis 2017; 57:71-83. [PMID: 28222526 PMCID: PMC6461741 DOI: 10.3233/jad-161187] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND It is currently unknown why people with Alzheimer's disease (AD) receive less pain medication and report pain less frequently. OBJECTIVE The purpose of this study was to determine the impact of AD on thermal psychophysics and resting-state functional connectivity (RSFC) among sensory, affective, descending modulatory, and default mode structures. METHODS Controls (n = 23, 13 = female) and age-matched people with AD (n = 23, 13 = females) underwent psychophysical testing to rate perceptions of warmth, mild, and moderate pain and then completed resting-state fMRI. Between groups analysis in psychophysics and RSFC were conducted among pre-defined regions of interest implicated in sensory and affective dimensions of pain, descending pain modulation, and the default mode network. RESULTS People with AD displayed higher thermal thresholds for warmth and mild pain but similar moderate pain thresholds to controls. No between-group differences were found for unpleasantness at any percept. Relative to controls, people with AD demonstrated reduced RSFC between the right posterior insula and left anterior cingulate and also between right amygdala and right secondary somatosensory cortex. Moderate pain unpleasantness reports were associated with increased RSFC between right dorsolateral prefrontal cortex and left ACC in controls only. CONCLUSIONS While AD had little effect on unpleasantness, people with AD had increased thermal thresholds, altered RSFC, and no association of psychophysics with RSFC in pain regions. Findings begin to elucidate that in people with AD, altered integration of pain sensation, affect, and descending modulation may, in part, contribute to decreased verbal pain reports and thus decreased analgesic administration.
Collapse
Affiliation(s)
- Todd B. Monroe
- School of Nursing, Vanderbilt University, Nashville, TN, USA
- Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
- Psychiatric Neuroimaging Program, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University, Nashville, TN, USA
| | - Paul A. Beach
- Department of Neurology & Ophthalmology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | | | - Mary S. Dietrich
- School of Nursing, Vanderbilt University, Nashville, TN, USA
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Baxter P. Rogers
- Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John C. Gore
- Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sebastian W. Atalla
- School of Nursing, Vanderbilt University, Nashville, TN, USA
- Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
- Psychiatric Neuroimaging Program, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ronald L. Cowan
- Psychiatric Neuroimaging Program, Vanderbilt University Medical Center, Nashville, TN, USA
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| |
Collapse
|
46
|
Stubbs B, Thompson T, Solmi M, Vancampfort D, Sergi G, Luchini C, Veronese N. Is pain sensitivity altered in people with Alzheimer's disease? A systematic review and meta-analysis of experimental pain research. Exp Gerontol 2016; 82:30-8. [DOI: 10.1016/j.exger.2016.05.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/19/2016] [Accepted: 05/30/2016] [Indexed: 11/24/2022]
|
47
|
de Tommaso M, Kunz M, Valeriani M. Therapeutic approach to pain in neurodegenerative diseases: current evidence and perspectives. Expert Rev Neurother 2016; 17:143-153. [DOI: 10.1080/14737175.2016.1210512] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Marina de Tommaso
- Neurophysiopathology of Pain Section, SMBNOS Department, Bari Aldo Moro University, Bari, Italy
| | - Miriam Kunz
- Department of General Practice, Section Gerontology, University Medical Center Groningen, Groningen, The Netherlands
| | | |
Collapse
|
48
|
de Tommaso M, Arendt-Nielsen L, Defrin R, Kunz M, Pickering G, Valeriani M. Pain in Neurodegenerative Disease: Current Knowledge and Future Perspectives. Behav Neurol 2016; 2016:7576292. [PMID: 27313396 PMCID: PMC4904074 DOI: 10.1155/2016/7576292] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 04/18/2016] [Accepted: 05/08/2016] [Indexed: 12/26/2022] Open
Abstract
Neurodegenerative diseases are going to increase as the life expectancy is getting longer. The management of neurodegenerative diseases such as Alzheimer's disease (AD) and other dementias, Parkinson's disease (PD) and PD related disorders, motor neuron diseases (MND), Huntington's disease (HD), spinocerebellar ataxia (SCA), and spinal muscular atrophy (SMA), is mainly addressed to motor and cognitive impairment, with special care to vital functions as breathing and feeding. Many of these patients complain of painful symptoms though their origin is variable, and their presence is frequently not considered in the treatment guidelines, leaving their management to the decision of the clinicians alone. However, studies focusing on pain frequency in such disorders suggest a high prevalence of pain in selected populations from 38 to 75% in AD, 40% to 86% in PD, and 19 to 85% in MND. The methods of pain assessment vary between studies so the type of pain has been rarely reported. However, a prevalent nonneuropathic origin of pain emerged for MND and PD. In AD, no data on pain features are available. No controlled therapeutic trials and guidelines are currently available. Given the relevance of pain in neurodegenerative disorders, the comprehensive understanding of mechanisms and predisposing factors, the application and validation of specific scales, and new specific therapeutic trials are needed.
Collapse
Affiliation(s)
- Marina de Tommaso
- Neurophysiopathology of Pain Section, SMBNOS Department, Bari Aldo Moro University, Bari, Italy
| | | | - Ruth Defrin
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Miriam Kunz
- Department of General Practice, Section Gerontology, University Medical Center Groningen, Groningen, Netherlands
| | - Gisele Pickering
- CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France
- Inserm, CIC 1405, Neurodol 1107, 63003 Clermont-Ferrand, France
| | - Massimiliano Valeriani
- Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
- Division of Neurology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| |
Collapse
|
49
|
|
50
|
Monroe TB, Gibson SJ, Bruehl SP, Gore JC, Dietrich MS, Newhouse P, Atalla S, Cowan RL. Contact heat sensitivity and reports of unpleasantness in communicative people with mild to moderate cognitive impairment in Alzheimer's disease: a cross-sectional study. BMC Med 2016; 14:74. [PMID: 27164846 PMCID: PMC4863331 DOI: 10.1186/s12916-016-0619-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 04/26/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Compared to healthy controls, people with Alzheimer's disease (AD) have been shown to receive less pain medication and report pain less frequently. It is unknown if these findings reflect less perceived pain in AD, an inability to recognize pain, or an inability to communicate pain. METHODS To further examine aspects of pain processing in AD, we conducted a cross-sectional study of sex-matched adults ≥65 years old with and without AD (AD: n = 40, female = 20, median age = 75; control: n = 40, female = 20, median age = 70) to compare the psychophysical response to contact-evoked perceptual heat thresholds of warmth, mild pain, and moderate pain, and self-reported unpleasantness for each percept. RESULTS When compared to controls, participants with AD required higher temperatures to report sensing warmth (Cohen's d = 0.64, p = 0.002), mild pain (Cohen's d = 0.51, p = 0.016), and moderate pain (Cohen's d = 0.45, p = 0.043). Conversely, there were no significant between-group differences in unpleasantness ratings (p > 0.05). CONCLUSIONS The between-group findings demonstrate that when compared to controls, people with AD are less sensitive to the detection of thermal pain but do not differ in affective response to the unpleasant aspects of thermal pain. These findings suggest that people with AD may experience greater levels of pain and potentially greater levels of tissue or organ damage prior to identifying and reporting injury. This finding may help to explain the decreased frequency of pain reports and consequently a lower administration of analgesics in AD.
Collapse
Affiliation(s)
- Todd B Monroe
- Vanderbilt University School of Nursing, Vanderbilt University Institute of Imaging Science, Vanderbilt Psychiatric Neuroimaging Program, Nashville, Tennessee, USA.
| | - Stephen J Gibson
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia
| | - Stephen P Bruehl
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - John C Gore
- Vanderbilt University Institute of Imaging Science, Nashville, Tennessee, USA
| | - Mary S Dietrich
- Vanderbilt Psychiatric Neuroimaging Program, Vanderbilt University Schools of Medicine and Nursing, Nashville, Tennessee, USA
| | - Paul Newhouse
- Vanderbilt Center for Cognitive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Sebastian Atalla
- Vanderbilt University School of Nursing, Vanderbilt University Institute of Imaging Science, Vanderbilt Psychiatric Neuroimaging Program, Nashville, Tennessee, USA
| | - Ronald L Cowan
- Vanderbilt Psychiatric Neuroimaging Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| |
Collapse
|