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Pain and dementia

A diagnostic challenge

Schmerz und Demenz

Eine diagnostische Herausforderung

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Abstract

Purpose

The aim was to present current knowledge about pain assessment in people with dementia and to discuss special challenges and possible solutions.

Methods

A literature search in MEDLINE® was performed.

Results

Due to the changing demographics of an aging population, an increasing number of people with dementia is expected. Many of these people will simultaneously suffer pain. Under-detection and under-treatment of pain in persons suffering from dementia is often described. As dementia progresses, the ability of the sufferer to verbally communicate his/her pain is often compromised, complicating the task of recognizing and treating pain. To improve pain recognition in dementia, many pain assessment tools have been developed. However, psychometric properties have to date been insufficiently examined.

Implications

Self-report ratings should be performed as long as justifiable. Behavioural pain assessment tools should be used in advanced dementia despite their current imperfections: in particular, the PAINAD for daily use and the PACSLAC at longer intervals. All available additional information about pain should be considered.

Zusammenfassung

Ziel

Ziel war es, den aktuellen Erkenntnisstand auf dem Gebiet der Schmerzerkennung bei Demenz darzustellen sowie die besonderen Herausforderungen und mögliche Lösungen zu diskutieren.

Methode

Es wurde eine Literaturrecherche in MEDLINE® durchgeführt.

Ergebnisse

Aufgrund der demographischen Entwicklung erwarten wir immer mehr Demenzkranke. Viele von ihnen leiden parallel unter Schmerzen. Probleme in der Schmerzerkennung sowie eine schmerztherapeutische Unterversorgung bei Demenzkranken werden häufig beschrieben. Mit Fortschreiten der Demenz schwindet die Fähigkeit, verbal Schmerzen auszudrücken, was die Schmerzerkennung wesentlich erschwert. So wurden in den letzten Jahren zahlreiche Instrumente zur Schmerzerkennung bei Demenzkranken entwickelt. Ihre Testgütekriterien sind aber häufig immer noch unzureichend untersucht.

Schlussfolgerung

Schmerzselbstbewertungsinstrumente sollten so lange wie möglich eingesetzt werden. Bei fortgeschrittener Demenz werden Fremdbewertungsinstrumente empfohlen: Trotz weiter bestehender Schwächen sind PAINAD für die tägliche Schmerzerfassung und PACSLAC für Kontrollen im Intervall zu empfehlen. Alle verfügbaren den Schmerz betreffenden zusätzlichen Informationen müssen berücksichtigt werden.

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Conflicts of interest

The corresponding author states the following: The PAINAD-G-II study is partially funded by a Forschungskolleg Geriatrie Grant from the Robert Bosch Foundation, Stuttgart, Germany and Mundipharma GmbH, Limburg, Germany. The corresponding author states that neither the Robert Bosch Foundation nor the Mundipharma GmbH had any influence on the content of this article.

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Authors and Affiliations

  1. Stipendiat Forschungskolleg Geriatrie, Robert Bosch Stiftung, AGAPLESION Bethesda Klinik Ulm, Akademisches Krankenhaus der Universität Ulm, Zollernring 26-28, 89073, Ulm, Deutschland

    A. Lukas, T. Nikolaus & M. Denkinger

  2. Diakoniekrankenhaus, Mannheim, Deutschland

    M. Schuler

  3. ehs Dresden, Dresden, Deutschland

    T.W. Fischer

  4. NARI, National Ageing Research Institute of Australia, The University of Melbourne and Melbourne Health, Melbourne, Australia

    S.J. Gibson & S.M. Savvas

Authors
  1. A. Lukas
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  2. M. Schuler
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  3. T.W. Fischer
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  4. S.J. Gibson
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  5. S.M. Savvas
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  6. T. Nikolaus
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  7. M. Denkinger
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Corresponding author

Correspondence to A. Lukas.

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Lukas, A., Schuler, M., Fischer, T. et al. Pain and dementia. Z Gerontol Geriat 45, 45–49 (2012). https://doi.org/10.1007/s00391-011-0272-4

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  • DOI: https://doi.org/10.1007/s00391-011-0272-4

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