[A version of this item appears in: Dementia: the Latest Evidence Newsletter (RWHT), Volume 2 Issue 1, August 2011].
It appears that some dementia patients prescribed antipsychotic drugs might have better treated with simple painkillers, according to research published in the BMJ which shows that painkillers significantly cut agitation.
Antipsychotic drugs are commonly used when people display the behavioural and psychological symptoms of dementia (BPSD), but these drugs have a beneficial effect for only a minority dementia patients. About 150,000 patients in the UK each year are prescribed antipsychotics unnecessarily, which usually worsen dementia symptoms and increase the risk of stroke and death.
Dementia patients may become aggressive or agitated as a result of pain, possibly because they are unable to express their discomfort in any other way. Pain may be under-treated in people with dementia because it is hard to recognise.
Researchers studied 352 patients in Norway with moderate or severe dementia in nursing homes. Half were given painkillers with every meal, and the others continued with their usual treatments, for a period of eight weeks. There was a 17% reduction in agitation in the group given the relatively risk-free painkillers; an improvement greater than could have been expected from the more harmful and expensive antipsychotic drugs.
Pain has been identified (indirectly) as cause of agitation and aggressive behaviour and this knowledge should spur GPs to re-examine the reasons why people with dementia may become agitated, instead of resorting to antipsychotic medication immediately. Improved pain management may decrease agitation in dementia.
Note: Painkillers should be given to patients only under the supervision of a doctor.
Hughes, J. (2011). Painkillers ‘may ease agitation’ in dementia patients. London: BBC News, July 18th 2011.
Hughes, J. (2011). Doctors find painkillers may reduce dementia symptoms. London: BBC News, July 18th 2011.
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Rosenberg, PB. Lyketsos, CG. [and] Plank Althouse, E. (2011). Treating agitation in dementia: A systematic pain management protocol may help. BMJ, July 17th 2011; 343: d3913.