PCPs need to know more about pain treatment in Alzheimer’s disease, experts say
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About half of patients with Alzheimer’s disease experience back pain, but only eight North American medical schools offer courses on geriatric pain, data show.
This has left much of the primary care workforce largely ill-equipped to meet patients’ needs, experts told Healio Primary Care.
“Historically, recognizing and treating this pain is not covered in medical school curricula,” Mariu Carlo Duggan, MD, MPH, clinical director of geriatric operations at Vanderbilt University Hospital, said in an interview.
Rebecca M. Edelmayer, PhD, director of scientific engagement education at the Alzheimer’s Association, said “there's an absolute need” to increase medical professionals’ skill sets on recognizing pain in patients with dementia, as pain can often manifest as symptoms of agitation or aggression when untreated.
“When we're thinking about patient-centered care for anyone living with dementia, we want to make sure that we are addressing pain as part of their treatment and care plan,” she said.
In a study published in Pain Medicine in June, Keelin Moehl, an MD candidate at the University of Pittsburgh School of Medicine, and colleagues found that medical students who were exposed to an e-learning module and an experiential geriatrics course “demonstrated improved confidence in evaluating and managing pain in patients with dementia.”
In fact, Kurt Kroenke, MD, MACP, a pain expert at Indiana University School of Medicine, said the module may even help practicing physicians who treat patients in the later stages of dementia.
“The standard approach of assessing pain” — primarily, speaking with the patient and asking questions — “may be less effective in patients with dementia whose memory and communication skills are decreased,” Kroenke told Healio Primary Care.
The module, he said, reviews “issues many PCPs may not know about,” such as asking patients use adjectives rather than numbers to describe their pain, listening and watching for verbal and behavioral cues of pain, and prescribing low doses of opioids to treat severe pain when other treatments are not effective.”
Duggan said there are at least 30 tools that physicians can use to assess pain in patients with dementia.
“Each tool incorporates a variety of self-reporting, observation, caregiver rating and patient-interactive information,” she said. “Each tool’s usefulness depends upon how advanced the dementia is.
In recognition of World Alzheimer’s Day, observed each Sept. 21 by Alzheimer’s Disease International to raise awareness of dementia, Healio Primary Care compiled a list of relevant stories for practicing physicians:
Personality traits during high school may predict later dementia risk
Personality traits exhibited during high school may be associated with dementia risk more than 5 decades later, according to findings of a retrospective cohort study published in JAMA Psychiatry. Read more.
Buprenorphine triples harmful adverse events in dementia
The commonly prescribed painkiller, buprenorphine, more than tripled psychiatric and neurological side effects among patients with dementia, data show. Read more.
VIDEO: Reduce prescribing in patients with dementia
Clinicians should consider nonpharmacological options when managing geriatric patients with advanced dementia, according to an expert. Read more
Personalized care plus social interaction benefits patients with dementia
Increasing the amount of social interaction for people with dementia living in nursing homes by as little as 1 hour per week improved quality of life, agitation and neuropsychiatric symptoms when combined with a person-centered care intervention, according to data. Read more.
Simple tool with ‘good accuracy’ predicts life expectancy in patients with dementia
Using routinely collected patient characteristics, researchers said they were able to predict the life expectancy of patients with dementia with “good accuracy.” Read more.
Editor’s note: More details about the e-module that Moehl and colleagues discuss can be found here.
References:
- Alzheimer's Disease International. September is World Alzheimer's Month. https://www.worldalzmonth.org. Accessed on September 14, 2020.
- University of Pittsburgh Department of Medicine. https://dom.pitt.edu/wp-content/uploads/2018/05/Winter-2018-newsletter.pdf. Update in Geriatrics, Winter 2018. Accessed Sept. 13, 2020.
- Van Kooten J, et al. BMC Geriatr. 2015;doi:10.1186/s12877-015-0025-0.
- Weiner DK, et al. J Am Geriatr Soc. 2014;doi:10.1111/jgs.12871