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Chronic pain in people living with dementia: challenges to recognising and managing pain, and personalising intervention by phenotype

Collins, Jemima T.; Harwood, Rowan H.; Cowley, Alison; Di Lorito, Claudio; Ferguson, Eamonn; Minicucci, Marcos F.; Howe, Louise; Masud, Tahir; Ogliari, Giulia; O'Brien, Rebecca; Azevedo, Paula S.; Walsh, David A.; Gladman, John R.F.

Chronic pain in people living with dementia: challenges to recognising and managing pain, and personalising intervention by phenotype Thumbnail


Authors

JEMIMA COLLINS Jemima.Collins.old@nottingham.ac.uk
Clinical Associate Professorin Health Care of Older People

Rowan H. Harwood

Alison Cowley

Claudio Di Lorito

EAMONN FERGUSON eamonn.ferguson@nottingham.ac.uk
Professor of Health Psychology

Marcos F. Minicucci

Louise Howe

Tahir Masud

Giulia Ogliari

Paula S. Azevedo

DAVID WALSH david.walsh@nottingham.ac.uk
Professor of Rheumatology

John R.F. Gladman



Abstract

Pain is common in people with dementia, and pain can exacerbate the behavioural and psychological symptoms of dementia. Effective pain management is challenging, not least in people with dementia. Impairments of cognition, communication and abstract thought can make communicating pain unreliable or impossible. It is unclear which biopsychosocial interventions for pain management are effective in people with dementia, and which interventions for behavioural and psychological symptoms of dementia are effective in people with pain. The result is that drugs, physical therapies and psychological therapies might be either underused or overused. People with dementia and pain could be helped by assessment processes that characterise an individual’s pain experience and dementia behaviours in a mechanistic manner, phenotyping. Chronic pain management has moved from a ‘one size fits all’ approach, towards personalised medicine, where interventions recommended for an individual depend upon the key mechanisms underlying their pain, and the relative values they place on benefits and adverse effects. Mechanistic phenotyping through careful personalised evaluation would define the mechanisms driving pain and dementia behaviours in an individual, enabling the formulation of a personalised intervention strategy. Central pain processing mechanisms are particularly likely to be important in people with pain and dementia, and interventions to accommodate and address these may be particularly helpful, not only to relieve pain but also the symptoms of dementia.

Journal Article Type Article
Acceptance Date Oct 28, 2022
Online Publication Date Jan 9, 2023
Publication Date 2023-01
Deposit Date Feb 2, 2023
Publicly Available Date Jan 10, 2024
Journal Age and Ageing (Deleted)
Electronic ISSN 1468-2834
Peer Reviewed Peer Reviewed
Volume 52
Issue 1
Article Number afac306
DOI https://doi.org/10.1093/ageing/afac306
Keywords Pain, dementia, phenotype, central mechanisms, older people
Public URL https://nottingham-repository.worktribe.com/output/16492885
Publisher URL https://academic.oup.com/ageing/article-abstract/52/1/afac306/6974848?redirectedFrom=fulltext
Additional Information This is a pre-copyedited, author-produced version of an article accepted for publication in Age and Ageing following peer review. The version of record Jemima T Collins, Rowan H Harwood, Alison Cowley, Claudio Di Lorito, Eamonn Ferguson, Marcos F Minicucci, Louise Howe, Tahir Masud, Giulia Ogliari, Rebecca O’Brien, Paula S Azevedo, David A Walsh, John R F Gladman, Chronic pain in people living with dementia: challenges to recognising and managing pain, and personalising intervention by phenotype is available online at: https://doi.org/10.1093/ageing/afac306.