Management of noncancer pain in community-dwelling persons with dementia
Management of noncancer pain in community-dwelling persons with dementia
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DOI：
10.1111/j.1532-5415.2006.00986.x
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发表时间：
2006-12-01
影响因子：
6.3
通讯作者：
Sachs, Greg A.
中科院分区：
文献类型：
--
作者：
Shega, Joseph W.;Hougham, Gavin W.;Sachs, Greg A.
目的：探讨痴呆患者非癌性疼痛的药物治疗，并确定与镇痛不足相关的预测因素。设计：观察性队列研究的横断面分析。地点：伊利诺斯州芝加哥的学术老年门诊诊所。参与者：共有115对，大多数是非裔美国人，由社区居住的痴呆症患者和他们的照顾者组成。测量：患者报告人口统计学、非癌性疼痛、功能、认知和抑郁。护理人员报告患者躁动和非处方和处方药物。结果：115例患者中有62例（54%）报告“平均每天”疼痛。超过一半的痴呆症患者“平均每天”报告疼痛，其护理人员没有报告使用止痛药。大多数报告使用镇痛剂的护理人员报告说，患者服用了世界卫生组织第一类药物。没有患者被开了III类（强阿片类）药物。115例患者中有53例（46%）存在潜在的镇痛不足。在logistic回归中，镇痛不足与年龄较大、精神状态检查分数小于10分和日常功能障碍相关。每增加一岁，出现止痛不足的可能性为1.07倍（95%可信区间(CI) = 1.01-1.14），如果受试者患有晚期痴呆，出现止痛不足的可能性为3.0倍（95% CI = 1.05-9.10），如果患者有任何日常生活活动障碍，出现止痛不足的可能性为2.5倍（95% CI = 1.01-6.25）。结论：在这个来自老年诊所的方便样本中，许多患有痴呆和非癌性疼痛的人没有接受药物治疗。止痛不足风险最大的患者年龄较大，患有中度至重度痴呆，日常生活活动受损。
OBJECTIVES: To explore the pharmacological treatment of noncancer pain in persons with dementia and identify predictors associated with insufficient analgesia.DESIGN: Cross-sectional analysis of an observational cohort study.SETTING: Academic outpatient geriatric clinic in Chicago, Illinois.PARTICIPANTS: A total of 115 dyads, mostly African American, consisting of community-dwelling persons with dementia and their caregivers.MEASUREMENTS: Patient report of demographics, noncancer pain, function, cognition, and depression. Caregiver report of patient agitation and over-the-counter and prescription medications.RESULTS: Sixty-two of 115 (54%) patients reported pain "on an average day." The caregivers of more than half of persons with dementia who reported pain "on an average day" did not report analgesic use. The majority of caregivers who reported analgesic use reported that patients took a World Health Organization Class I medication. No patients had been prescribed a Class III (strong opioid) drug. Fifty-three of 115 (46%) patients had potentially insufficient analgesia. In the logistic regression, insufficient analgesia was associated with greater age, Mini-Mental State Examination score of less than 10, and impairment in daily functioning. Insufficient analgesia was 1.07 times as likely (95% confidence interval (CI) = 1.01-1.14) for each additional year of age, 3.0 times as likely (95% CI = 1.05-9.10) if the subject had advanced dementia, and 2.5 times as likely (95% CI 1.01-6.25) if the patient had any impairment in activities of daily living.CONCLUSION: In this convenience sample from a geriatric clinic, many persons with dementia and noncancer pain were not receiving pharmacological treatment. Those at greatest risk for insufficient analgesia were older, had moderate to severe dementia, and experienced impairments in activities of daily living.