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P1–365: High use of opioids in people with dementia
Author(s) -
JensenDahm Christina,
Aastrup Aske,
Gasse Christiane,
Mortensen Preben Bo,
Waldemar Gunhild
Publication year - 2013
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2013.05.592
Subject(s) - dementia , medicine , danish , medical prescription , fentanyl , anesthesia , disease , pharmacology , linguistics , philosophy
Background: Previous studies have shown a reduced reporting of pain and a lower use of analgesics in patients with Alzheimer’s disease (AD) compared to healthy controls (HC). Previous experimental pain studies have shown that AD patients have an increased tolerance to pain, which may explain fewer complaints. We wished to investigate the perception of pain using heat and pressure stimuli in a population of mild-moderate AD. Methods: 28 patients with probable AD (MMSE 16-26) and 28 sexand age -matched cognitively intact HC were examined using quantitative sensory testing with determination of warmth detection threshold (WDT), heat pain threshold (HPT) and suprathreshold stimuli. The participants were also tested using a pressure algometer with determination of pain threshold and tolerance. Results: We found no significant difference between groups for WDT (AD: 35.48 C [33.88 C 37.15 C]; HC: 34.83 C [34.12 C 35.56 C], p 1⁄4 0.26) and HPT (AD: 40.27 C [37.07 C 43.65]; HC: 41.78 C [40.46 C 43.15 C], p 1⁄4 0.14). We found a similar threshold for pressure algometry (AD: 112.59 kPa [87.8 kpa 144.38 kPa]; HC: 135.21 kPa [114.18 kPa 159.92 kPa], p 1⁄4 0.15), but a significantly lower tolerance (AD: 214,73 [180.05 kPa 254.08 kPa]; HD: 283.14 kPa [251.19 kPa 319.15 kPa] p1⁄4 0.0031). Conclusions: Contrary to previous results, which have shown an increased tolerance for pain, we found that patients with AD have an increased sensitivity to pain. Our results are in line with a recent fMRI study showing increased brain activity in response to pain(1). Our results suggest that the reduced pain reporting in AD, compared with HC, cannot be explained by impaired pain processing resulting in increased tolerance. Alternative explanations may include impaired communication, memory problems or anosognosia associated with AD. (1) Cole LJ, Farrell MJ, Duff EP, Barber JB, Egan GF, Gibson SJ. Pain sensitivity and fMRI pain-related brain activity in Alzheimer’s disease. Brain 2006 Nov;129:2957-2965.