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Efficacy of pain treatment on mood syndrome in patients with dementia: a randomized clinical trial
Author(s) -
Husebo B. S.,
Ballard C.,
Fritze F.,
Sandvik R. K.,
Aarsland D.
Publication year - 2014
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/gps.4063
Subject(s) - mood , apathy , dementia , randomized controlled trial , medicine , depression (economics) , anxiety , psychiatry , physical therapy , psychology , disease , economics , macroeconomics
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.