Undertreated pain in dementia

A review in the BMJ describes the frequent undertreatment of pain in dementia and its increased risk with dementia severity. Pain should be regularly assessed in patients with diseases such as Parkinson's disease and multiple sclerosis, the authors say, and assessment should commence in the early stages of the disease when cognitive function is relatively preserved.Dr Scherder and colleagues describe data on the undertreatment of pain in dementia. Research observations showing that fewer analgesics are prescribed for patients with low cognitive performance (compared to other patient populations) "stress the importance of increasing our knowledge of pain recognition in this population," they say. The authors discuss pain assessment tools commonly used in communicative patients, such as the self report pain rating scale, but say that these scales measure only the presence and intensity of pain and do not measure the "motivational-affective aspects" of pain. They suggest that observation scales, commonly used in non-communicative patients, should be used in all patients, irrespective of their cognitive status. However, observation scales are often an imprecise measurement of pain in dementia, due to the atypical behaviour exhibited in these patients. "Assessing for pain only with tools that include typical pain behaviours but do not recognise subtle behaviours and changes in usual activities may result in the under-recognition of pain in this population," they say. They suggest that the primary goal of future research is the development of tools to better recognise pain in non-communicative patients with dementia. The lack of scientific examination of pain during the course of diseases such as Parkinson's disease and multiple sclerosis is "alarming", say the authors. They believe that the resulting lack of knowledge, "hampers the development of effective pain treatment strategies with respect to not only the painful conditions in the cognitively impaired stage but also the side effects of drugs in Parkinson's disease and multiple sclerosis."Reference...