Efficacy of pain treatment on mood syndrome in patients with dementia: a randomized clinical trial

• Published in: International journal of geriatric psychiatry Vol. 29; no. 8; pp. 828 - 836
• Main Authors: Husebo, B. S., Ballard, C., Fritze, F., Sandvik, R. K., Aarsland, D.
• Format: Journal Article
• Language: English
• Published: Hove Blackwell Publishing Ltd 01.08.2014; Psychology Press; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; Analgesics - therapeutic use; anxiety; Apathy; Biological and medical sciences; Clinical trials; Cluster Analysis; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Dementia; Dementia - psychology; depression; Female; General aspects; Geriatric psychiatry; Geriatrics; Humans; Male; Medical sciences; Medicin och hälsovetenskap; Mental depression; Mental Disorders - prevention & control; Middle Aged; Mood Disorders - prevention & control; Neurology; Norway; nursing home; Nursing Homes; pain; Pain - drug therapy; Pain - psychology; Pain management; Pain Management - methods; Patients; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Severity of Illness Index; Norway; Mood disorder; Human; Affect affectivity; Long stay; Nursing home for the aged; Treatment efficiency; Anxiety disorder; Controlled therapeutic trial; Depression; Patient; Care; Syndrome; Randomization; Pain; Mood; Clinical trial; Degenerative disease; Anxiety; Homes for the aged; Nursing home; Dementia; Geriatrics; anxiety; dementia; nursing home; pain; depression
• ISSN: 0885-6230; 1099-1166; 1099-1166
• DOI: 10.1002/gps.4063

Background Depression is common in nursing home (NH) patients with dementia, and often clustered with anxiety and other mood symptoms. An association between pain and depressive symptoms has been reported, but the impact of pain management on depression and other mood symptoms has not been investigated. Objective Secondary analyses of a cluster randomized clinical trial examine the response of dementia‐related mood symptoms to a Stepwise Protocol of Treating Pain. Method Three‐hundred fifty‐two patients with moderate and severe dementia and significant behavioural disturbances, related to 60 clusters (i.e. clusters defined as single independent NH units) in 18 NHs of Western Norway, were included. All patients in the intervention group received individual daily pain treatment with paracetamol, extended release morphine, buprenorphine transdermal patch or pregabaline for 8 weeks, with additional follow‐up assessment 4 weeks after completion of the intervention. Clusters randomized to control received usual treatment. A mood cluster consisting of depression, anxiety, sleep disorders, apathy and appetite items from the Neuropsychiatric Inventory‐Nursing Home (NPI‐NH) was the primary outcome. Results Analysed by Mann–Whitney U‐tests, Stepwise Protocol of Treating Pain conferred significant benefit in treatment of the NPI‐NH mood cluster (F = 13.4, df = 1;299, p < 0.001) and depression (F = 2.0, df = 1;301, p = 0.025). Further analyses highlighted improvements in apathy (F = 5.3, df = 1;300, p = 0.017), night‐time behaviours (F = 3.1, df = 1;301, p = 0.050), and appetite items (F = 11.6, df = 1;301, p = 0.005), but not irritability (p = 0.092) and anxiety (p = 0.125). Conclusion Mood symptoms including depression significantly improved with pain treatment, emphasizing the importance of more rigorous treatment of pain in agitated people with dementia. Findings have potentially immediate clinical relevance. © 2013 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.