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.

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.

Citation

Collins, J. T., Harwood, R. H., Cowley, A., Di Lorito, C., Ferguson, E., Minicucci, M. F., …Gladman, J. R. (2023). Chronic pain in people living with dementia: challenges to recognising and managing pain, and personalising intervention by phenotype. Age and Ageing, 52(1), Article afac306. https://doi.org/10.1093/ageing/afac306

• 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
• 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.