Pain management in patients with dementia.
Pain management in patients with dementia.
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DOI：
10.2147/cia.s36739
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发表时间：
2013
影响因子：
3.6
通讯作者：
Corbett A
中科院分区：
文献类型：
--
作者：
Achterberg WP;Pieper MJ;van Dalen-Kok AH;de Waal MW;Husebo BS;Lautenbacher S;Kunz M;Scherder EJ;Corbett A
据估计，全世界有3500万痴呆症患者，其中50%经历着经常性的疼痛。尽管如此，目前对这一患者组的疼痛评估和治疗是不够的。除了疼痛引起的不适和痛苦外，它还经常是行为症状的根本原因，这可能导致抗精神病药物的不适当治疗。疼痛还会导致治疗和护理中的进一步并发症。这篇综述探讨了痴呆症疼痛管理的四个关键视角，并提出了实践和研究的建议。讨论的第一个角度是，在阿尔茨海默病和其他痴呆症中，关于痴呆症神经病理学对疼痛感知和处理的影响的文献中存在相当大的不确定性，在这些疾病中，白质病变和脑萎缩似乎影响了疼痛的神经生物学。第二种观点考虑了对痴呆症患者疼痛的评估。这是具有挑战性的，特别是因为这些个人的自我报告能力有限，这意味着评估在很大程度上依赖于观察方法。有许多工具可用，但这些工具的心理测量质量和临床用途尚不确定。止痛药有效治疗(第三种观点)的证据也是有限的，很少有统计上有效的试验。最有希望的证据支持使用阶梯式治疗方法，并表明疼痛和行为干预对这些重要症状都有好处。第四种观点认为，由于各级卫生保健专业人员缺乏足够的培训和教育，迫切需要以证据为基础的指导，因此在疼痛管理方面还存在困难。为了解决目前痴呆症疼痛管理不足的问题，需要一种全面的方法。这将包括一个准确、有效的评估工具，该工具对不同类型的疼痛和治疗效果敏感，并为所有环境中的护理人员提供更好的培训和支持。
There are an estimated 35 million people with dementia across the world, of whom 50% experience regular pain. Despite this, current assessment and treatment of pain in this patient group are inadequate. In addition to the discomfort and distress caused by pain, it is frequently the underlying cause of behavioral symptoms, which can lead to inappropriate treatment with antipsychotic medications. Pain also contributes to further complications in treatment and care. This review explores four key perspectives of pain management in dementia and makes recommendations for practice and research. The first perspective discussed is the considerable uncertainty within the literature on the impact of dementia neuropathology on pain perception and processing in Alzheimer’s disease and other dementias, where white matter lesions and brain atrophy appear to influence the neurobiology of pain. The second perspective considers the assessment of pain in dementia. This is challenging, particularly because of the limited capacity of self-report by these individuals, which means that assessment relies in large part on observational methods. A number of tools are available but the psychometric quality and clinical utility of these are uncertain. The evidence for efficient treatment (the third perspective) with analgesics is also limited, with few statistically well-powered trials. The most promising evidence supports the use of stepped treatment approaches, and indicates the benefit of pain and behavioral interventions on both these important symptoms. The fourth perspective debates further difficulties in pain management due to the lack of sufficient training and education for health care professionals at all levels, where evidence-based guidance is urgently needed. To address the current inadequate management of pain in dementia, a comprehensive approach is needed. This would include an accurate, validated assessment tool that is sensitive to different types of pain and therapeutic effects, supported by better training and support for care staff across all settings.