TY - JOUR
T1 - How, Why and Where it Hurts—Breaking Down Pain Syndrome Among Nursing Home Patients With Dementia
T2 - A Cross-Sectional Analysis of the COSMOS Trial
AU - Wagatsuma, Shunta
AU - Yamaguchi, Taizo
AU - Berge, Line I.
AU - Husebo, Bettina
AU - Habiger, Torstein F.
AU - Nouchi, Rui
AU - Angeles, Renira C.
N1 - Funding Information:
We thank the patients, their relatives, and the NH staff for their willingness and motivation, which made this work possible. The COSMOS trial is financed by the Research Council of Norway (sponsor's protocol code 222113/H10). The Rebekka Ege Hegermann's Foundation funded all costs incurred in executing the study. TH is financed by the University of Bergen. RA and LI Berge are financed by the Research Council of Norway (sponsor's protocol code 273581). BSH would like to thank the G.C. Rieber Foundation and the Norwegian Government for supporting our work at the Centre for Elderly and Nursing Home Medicine, University of Bergen, Norway. Parts of the work (DDS) were carried out at the Biostatistics and data analysis core facility (BIOS), University of Bergen. This work was one of the collaborative studies between the University of Bergen and Tohoku University. Mr. Shunta Wagatsuma and Mr. Taizo Yamaguchi are undergraduate students at the School of Medicine, Tohoku University. This study is also supported by JSPS KAKENHI Grant Number 19H05003 (Grant-in-Aid for Scientific Research on Innovative Areas), 19H01760 (Grant-in-Aid for Scientific Research (B), and the JSPS Leading Initiative for Excellent Young Researchers (LEADER) program. None of the funding sources had any involvement in the study design, collection, analysis, interpretation of data, or the writing of the paper.
Funding Information:
We thank the patients, their relatives, and the NH staff for their willingness and motivation, which made this work possible. The COSMOS trial is financed by the Research Council of Norway (sponsor's protocol code 222113/H10). The Rebekka Ege Hegermann's Foundation funded all costs incurred in executing the study. TH is financed by the University of Bergen. RA and LI Berge are financed by the Research Council of Norway (sponsor's protocol code 273581). BSH would like to thank the G.C. Rieber Foundation and the Norwegian Government for supporting our work at the Centre for Elderly and Nursing Home Medicine, University of Bergen , Norway. Parts of the work (DDS) were carried out at the Biostatistics and data analysis core facility (BIOS), University of Bergen. This work was one of the collaborative studies between the University of Bergen and Tohoku University. Mr. Shunta Wagatsuma and Mr. Taizo Yamaguchi are undergraduate students at the School of Medicine, Tohoku University. This study is also supported by JSPS KAKENHI Grant Number 19H05003 (Grant-in-Aid for Scientific Research on Innovative Areas), 19H01760 (Grant-in-Aid for Scientific Research (B), and the JSPS Leading Initiative for Excellent Young Researchers (LEADER) program. None of the funding sources had any involvement in the study design, collection, analysis, interpretation of data, or the writing of the paper.
Publisher Copyright:
© 2020 American Society for Pain Management Nursing
PY - 2021/6
Y1 - 2021/6
N2 - Background: Between 40%-60% of nursing home patients with dementia suffer from chronic and acute pain despite increasing their analgesic drug prescription. Aims: Determine the locations and intensity of pain and the association between quality of life (QoL) and four stratified pain–analgesic groups: (1) pain—analgesics treatment; (2) pain—no analgesics; (3) no pain—analgesics treatment; and (4) no pain—no analgesics. Design: Multicenter, multicomponent cluster randomized controlled Communication, Systematic assessment and treatment of pain, Medication review, Occupational therapy, and Safety - an effectiveness (COSMOS) trial. Participants: At baseline, 723 nursing home patients were enrolled; 463 were completely evaluated for the presence of pain and included in the cross-sectional analyses. Methods: Data were collected using the following tests: Cognitive function (Mini-Mental-State Evaluation [MMSE]); Quality of Life in Late stage of Dementia (QUALID); Dementia-Specific QoL (QUALIDEM); Mobilization–Observation–Behavior–Intensity–Dementia Pain Scale (MOBID-2); and number of analgesic drug prescriptions. Analysis of covariance (ANCOVA) was used to compare pain and QoL across pain–analgesics groups. Results: The majority of participants (78%) had moderate-to-severe dementia, were female (74%), and a mean age of 86.7 years. Almost 44% reported clinically significant pain, whereas 69% had ≥2 pain locations, especially in the musculoskeletal system. Some 33.5% of participants had pain receiving analgesics, 10% had pain with no analgesics, and 27% had no pain receiving analgesics. Patients evaluated with clinically significant pain intensity scores had lower QoL (<.001) compared with assessments relying on different pain locations. Conclusion: Untreated musculoskeletal and multi-located pain is still common in nursing home patients with dementia. A significant share without pain receive analgesics. Proper pain assessment and regular re-assessment are prerequisites for the prescribing and deprescribing of analgesics. Pain intensity scores are more significantly connected to QoL. This must be stressed when evaluating pain and QoL.
AB - Background: Between 40%-60% of nursing home patients with dementia suffer from chronic and acute pain despite increasing their analgesic drug prescription. Aims: Determine the locations and intensity of pain and the association between quality of life (QoL) and four stratified pain–analgesic groups: (1) pain—analgesics treatment; (2) pain—no analgesics; (3) no pain—analgesics treatment; and (4) no pain—no analgesics. Design: Multicenter, multicomponent cluster randomized controlled Communication, Systematic assessment and treatment of pain, Medication review, Occupational therapy, and Safety - an effectiveness (COSMOS) trial. Participants: At baseline, 723 nursing home patients were enrolled; 463 were completely evaluated for the presence of pain and included in the cross-sectional analyses. Methods: Data were collected using the following tests: Cognitive function (Mini-Mental-State Evaluation [MMSE]); Quality of Life in Late stage of Dementia (QUALID); Dementia-Specific QoL (QUALIDEM); Mobilization–Observation–Behavior–Intensity–Dementia Pain Scale (MOBID-2); and number of analgesic drug prescriptions. Analysis of covariance (ANCOVA) was used to compare pain and QoL across pain–analgesics groups. Results: The majority of participants (78%) had moderate-to-severe dementia, were female (74%), and a mean age of 86.7 years. Almost 44% reported clinically significant pain, whereas 69% had ≥2 pain locations, especially in the musculoskeletal system. Some 33.5% of participants had pain receiving analgesics, 10% had pain with no analgesics, and 27% had no pain receiving analgesics. Patients evaluated with clinically significant pain intensity scores had lower QoL (<.001) compared with assessments relying on different pain locations. Conclusion: Untreated musculoskeletal and multi-located pain is still common in nursing home patients with dementia. A significant share without pain receive analgesics. Proper pain assessment and regular re-assessment are prerequisites for the prescribing and deprescribing of analgesics. Pain intensity scores are more significantly connected to QoL. This must be stressed when evaluating pain and QoL.
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U2 - 10.1016/j.pmn.2020.11.014
DO - 10.1016/j.pmn.2020.11.014
M3 - Article
C2 - 33431262
AN - SCOPUS:85099263422
SN - 1524-9042
VL - 22
SP - 319
EP - 326
JO - Pain Management Nursing
JF - Pain Management Nursing
IS - 3
ER -