Pain Killers Beat Antipsychotics for Agitation
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Many dementia patients are being treated with antipsychotic medications, but a new study shows that simple pain relievers may be a better alternative.
Nearly one in five patients in the study became significantly less agitated and aggressive after treatment with painkillers. The project is a collaborative effort between researchers in Norway and England.
Pain management for aggression and agitation
The study included 352 patients with moderate to serious dementia who exhibited significant behavioural problems such as aggression and agitation.
During the eight-week study, all patients received their usual treatment, but half of them received pain treatment in addition.
Agitation is a common symptom of dementia; patients can become anxiety-ridden, upset and short-tempered.
Many receive antipsychotic medications intended to reduce their behavioural disturbances, but antipsychotics have a powerful sedative effect and can even exacerbate other dementia symptoms and increase the risk of stroke.
Pain leads to aggressiveness
Dr Husebø is carrying out post-doctoral research at the University of Bergen’s Department of Public Health and Primary Health Care. The study, which she heads, receives funding from the Research Programme on Health and Care Services (HELSEOMSORG) under the Research Council of Norway. She explained,
“The improvement the patients experienced was greater than would have been expected from treatment with antipsychotics.”
Advertisement“We hypothesised that behavioural disturbances in dementia patients are sometimes due to pain. These patients cannot always communicate to their caregivers that they are in pain, and aggression and agitation become their way of expressing it.”
Recurrence after reduction
In the intervention group, patients who were not already taking pain medication were given paracetamol (acetaminophen). Patients who were already taking some form of analgesic painkiller received low doses of morphine or buprenorphine, while those who appeared to suffer neuropathic pain received an antiepileptic drug.
After the eight weeks, the pain treatment was gradually reduced and the intervention-group patients showed marked improvement. But four weeks later the behavioural disturbances began recurring. Dr. Husebø emphasized,
“Some people may explain away these positive results by claiming we further sedated the patients. But throughout the study we took control measurements that showed the activity level (in daily living and cognition) of both groups remained unchanged during the eight weeks of pain management.”
“Pain assessment training needed”
She believes the results indicate that pain management should be integrated into the clinical treatment of people with dementia in nursing homes.
“Pain assessment is critical in managing pain properly. In the future we must ensure that all nursing home databases have standardized tools for assessing pain based on observation of the patients. Personnel will need training to use these tools, and routines need to be developed to make certain that the tools are actually employed.”
Dr Husebø stresses, however, that pain management is not a complete solution but rather part of a comprehensive plan in which activity and communication are essential elements.
Hawthorne effect triggered
The researchers in the study recorded some behavioral improvement in control-group patients as well, i.e. those who did not receive pain medication. This may be explained by the Hawthorne effect – that taking part in a study can in itself produce temporary, positive changes. Dr. Husebø elaborated,
“The nursing home personnel in the study received good training and follow-up. This enhanced knowledge and awareness of the issue in general, which in turn had an impact on all patients, not only those whose treatment was altered.”
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The results have been published in the British Medical Journal.
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I agree with the finding that painkillers help people who have dementia. I have seen it in my own life. I have FTD diagnosed over 3 years ago. Before that I was diagnosed with Complex Regional Pain Syndrome which happened after a surgical complication.
My neurologist/pain doctor told me 6 months ago that research has shown that CRPS, fibromyalgia, etc. is caused by antibodies that usually protect the body turn rogue (like an autoimmune disease in which the cells of the body attack the body.) These rogue antibodies in people who have them usually are activated after an injury or a surgery. It can be something as minor as a sprained ankle. Even though the original injury heals, rogue antibodies come in and attack the nerves at this place causing pain and also death of neurons. These rogue antibodies spread through nerve pathways like cancer cells spread through the body.
I have been on pain medicine for many years. My FTD is progressing more slowly and even though I have hallucinations, I am always aware that they are not real. One of my theories after I found out about the rogue antibodies is that somehow my pain medicine might be helping my dementia.
I hope that doctors start using pain meds for treatment. I primarily use narcotics. They have gotten a bad rap because of the war on drugs. If you do research, you will find that narcotics are more benign that most over the counter meds. Yes, you do become physically dependent but this is not the same as addiction. Under the supervision of a doctor, a patient using it for health reasons never gets high.
Unfortunately, many doctors have become afraid to prescribe them because past DEA interference with doctor's prescribing narcotics as well as future threats from the FDA.
Tylenol is dangerous to be taken on a long term basis because it can hurt the liver. Non-inflammatory steroids such as advil can overtime cause life threatening GI problems especially in people with immune problems.