AIM: To assess the effectiveness of psychosocial interventions on pain in older adults living with dementia.
DESIGN: A systematic review with meta-analysis of randomized controlled trials.
DATA SOURCES: Scopus, ProQuest, EBSCO (CINAHL and MEDLINE), PubMed, OVID (PsycINFO), Web of Science, and Cochrane Library were searched from their inception up to 2 May 2018.
REVIEW METHODS: Risk of bias assessment and meta-analysis were conducted according to the Cochrane methods using RevMan 5.3 and findings were generated using the GRADE profiler software.
RESULTS: Eight studies met the inclusion criteria, but the quality of the current evidence was low to moderate. Results showed that psychosocial interventions significantly reduced the observational pain score and pain medication. Subgroup analyses indicated that sensory stimulation and individual interventions showed a reduction in observational pain in people with dementia.
CONCLUSION: Findings suggest that psychosocial interventions may be potentially effective alternatives for pain management in people with dementia. However, caution is needed in interpreting these results due to limited studies, risk of bias and heterogeneity across studies. Furthermore, well-designed research is needed on psychosocial interventions to strengthen quality of pain management in people with dementia.
IMPACT: This review synthesized current evidence using psychosocial interventions to manage pain in people with dementia. Findings suggest that psychosocial interventions may lead to a potential reduction in pain and pain medication in people with dementia. Healthcare providers may wish to integrate psychosocial interventions as part of the multimodal approach to the management of pain in people living with dementia.
As a GP, I find it is relevant to learn that psychosocial interventions may be potentially effective alternatives for pain management in people with dementia. However, caution is needed in interpreting these results due to limited studies, risk of bias and heterogeneity across studies.
The findings suggest probable benefit without adverse effects with psychosocial interventions for pain management. Although the authors describe the studies as providing low to moderate quality evidence, the favorable risk to benefit ratio in a patient population at risk for adverse medication effects strongly supports the use of non-pharmacologic interventions for pain management.
The issue of pain management in older adults with dementia is very challengeable in long time care facility. I am very much looking forward to more research in the future.
The heterogeneity of the interventions (sensory stimulation–reflexology, massage, ear acupressure, music, showering, Tai Chi, passive movement) makes it difficult to draw clinically useful conclusions. It's also limited by lack of information on changes in analgesic use in most of the studies.
Inconclusive results with uncertain applicability.
Only a small number of studies met the inclusion criteria and the poor quality of the evidence lowers confidence in the results. It is important to remember "the same principles of pain management apply equally to people with and without dementia and that psychosocial interventions, such as music therapy, exercise, or relaxation, are considered useful...".
As a clinical psychologist specializing in pain management, I found this study to be interesting especially since the authors provided their own evaluation of their study on page 2 of the article which includes recommendations for future research, practice policy, and education.