PAIN+ CPN

I am an older adult with dementia experiencing chronic pain. Will psychosocial interventions help me to manage and reduce my pain?


Psychosocial interventions may reduce pain for older adults with dementia living in long-term care facilities. Interventions given on an individual basis, and those using sensory stimulation were shown to be effective at reducing pain.  Psychosocial interventions may not influence the use of pain medication.

What is the evidence?


Researchers looked at older adults with dementia or mild cognitive impairment who received psychosocial treatments and compared them to those who received usual care or another treatment. They measured pain levels and use of pain medications. They found that:

  • Patients who had psychosocial interventions had lower pain scores than people with other interventions
  • Interventions used either sensory stimulation or physical activity. Patients receiving sensory stimulation interventions had reduced pain compared with usual care or other treatments, but those receiving physical activity interventions did not.
  • Individual psychosocial interventions reduced pain, but group-based psychosocial interventions did not.
  • Only one study measured use of pain medications and did not find a difference between groups.
  • Most of the studies took place in long term care facilities. One study took place in the community.
  • The results of this review were based on low or very low quality of evidence.


What kind of study was this?


This was a systematic review. A systematic review summarises all available studies on a health care intervention to provide high quality evidence on the effectiveness of that health care intervention.

Who participated in the study? This review included 8 randomized trials involving 462 older adults with dementia or mild cognitive impairment, living in long-term care facilities or in the community. These studies took place in the USA, Netherlands, Australia, France, and Spain. The included patients had various levels of dementia (mild, moderate, or advanced), and different types of pain (cancer pain, chronic pain, or the pain type was not specified).

How was the study done? The reviewers included studies that compared psychosocial interventions with no treatment, usual care, or an alternative treatment.


Psychosocial interventions

vs

Usual care/alternative treatments


Two types of psychosocial interventions were included:

Sensory stimulation: These interventions included reflexology, massage, ear acupressure, music, and showering.

Physical activity interventions: Tai Chi and passive movement therapy.

Formats for these interventions included individual or group therapies. Frequency of interventions ranged from once per week to every day. Sessions lasted from 10 minutes to 2 hours, and lasted from 4 to 20 weeks.




The comparison groups varied in these studies, and included no treatment, usual care, friendly visits, painting, routine activities, and reflexology.


Why was this research done?


Pain medications may have serious side effects in older adults, including confusion, falls, and personality changes. Psychosocial interventions may be helpful to manage pain in older adults.

Although pain affects up to half of nursing home residents with dementia and is one of the most common problems for people with dementia, they are often not included in pain research. This makes it difficult to apply the results of this research to people with dementia. People with dementia also have reduced cognitive function and may have less ability to verbalize, which makes it more difficult to implement pain management interventions.

The authors of this study wanted to explore the effectiveness of psychosocial interventions as supportive modalities to manage pain, in older adults with dementia in long-term care or in the community.


This Evidence Summary is based on the following article:

Pu L, Moyle W, Jones C, et al. Psychosocial interventions for pain management in older adults with dementia: A systematic review of randomized controlled trials. J Adv Nurs. 2018 Dec 10. doi: 10.1111/jan.13929. PubMed

Published: Friday, March 29, 2019