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17-07-2011 | General practice | Article

Painkillers cut agitation in dementia

Abstract

BMJ 2011; 343: d4065

Pain management can help reduce agitation in nursing home residents with moderate-to-severe dementia, a study reveals.

The study investigators, from Norway and England, say that use of painkillers could thereby help reduce the number of prescriptions for antipsychotics and other psychotropic drugs in such patients.

Writing in the BMJ, Professor Clive Ballard (Kings College London) and team explain that although antipsychotics are often given as first line treatment for agitation and aggression in patients with dementia, the drugs are powerful sedatives, and are thought to cause 1600 excess strokes and 1800 deaths a year in the UK alone.

Noting that pain may often underlie such behaviour, the team proposed that more effective treatment of undiagnosed pain could offer an alternative approach.

To investigate, the researchers compared 8 weeks of individual daily pain management, according to a stepwise protocol, with usual treatment and care in 352 patients with moderate or severe dementia and behavioural disturbances.

Results showed that agitation was reduced among patients receiving the pain management compared with those receiving usual treatment and care, with the benefit emerging at 2 weeks and maintained at 8 weeks.

Similar results were seen for aggression and pain; however, activities of daily living and cognition were no different between the intervention and usual care groups.

Professor Ballard and colleagues conclude that "a standardised approach to improved pain management is a practical intervention that would be straightforward to implement widely for the benefit of agitation in residents of nursing homes with dementia".

GP News is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Caroline Price