Morrison R S, Siu A L
The Hertzberg Palliative Care Institute of the Department of Geriatrics and Adult Development, The Mount Sinai School of Medicine, New York, NY 10029, USA.
J Pain Symptom Manage. 2000 Apr;19(4):240-8. doi: 10.1016/s0885-3924(00)00113-5.
Advanced dementia patients may be at substantial risk for undetected or undertreated pain. To examine the treatment of pain following hip fracture, a prospective cohort study was conducted in an academic teaching hospital. Fifty-nine cognitively intact elderly patients with hip fracture and 38 patients with hip fracture and advanced dementia were assessed daily. The cognitively intact patients rated their pain on a numeric scale ranging from 0 (none) to 4 (very severe). Analgesics prescribed and administered were recorded and compared to hip fracture patients with advanced dementia. The advanced dementia patients received one-third the amount of morphine sulfate equivalents as the cognitively intact patients. Forty-four percent of cognitively intact individuals reported severe to very severe pain preoperatively and 42% reported similar pain postoperatively. Half the cognitively intact patients who experienced moderate to very severe pain were prescribed inadequate analgesia for their level of pain. Eighty-three percent of cognitively intact patients and 76% of dementia patients did not receive a standing order for an analgesic agent. These data reveal that a majority of elderly hip fracture patients experienced undertreated pain. The fact that advanced dementia patients received one-third the amount of opioid analgesia as compared to cognitively intact subjects-40% of whom reported severe pain postoperatively-suggests that the majority of dementia patients were in severe pain postoperatively. This study and others suggest that directed interventions to improve pain detection and alter physician prescribing practices in the cognitively impaired are needed.
晚期痴呆患者可能面临未被发现或治疗不足的疼痛的重大风险。为了研究髋部骨折后的疼痛治疗情况，在一家学术教学医院进行了一项前瞻性队列研究。对59名认知功能正常的老年髋部骨折患者和38名患有髋部骨折及晚期痴呆的患者进行每日评估。认知功能正常的患者用0（无）至4（非常严重）的数字量表对其疼痛进行评分。记录所开和所给的镇痛药，并与患有晚期痴呆的髋部骨折患者进行比较。晚期痴呆患者接受的硫酸吗啡等效剂量仅为认知功能正常患者的三分之一。44%认知功能正常的个体术前报告有重度至非常重度疼痛，42%术后报告有类似疼痛。经历中度至非常重度疼痛的认知功能正常患者中，有一半患者所开的镇痛药剂量与其疼痛程度不匹配。83%认知功能正常的患者和76%痴呆患者未收到镇痛药的长期医嘱。这些数据表明，大多数老年髋部骨折患者的疼痛治疗不足。与认知功能正常的受试者相比，晚期痴呆患者接受的阿片类镇痛药剂量仅为其三分之一，其中40%的认知功能正常患者术后报告有重度疼痛，这表明大多数痴呆患者术后处于重度疼痛中。这项研究及其他研究表明，需要采取针对性干预措施，以改善对认知障碍患者的疼痛检测，并改变医生的开药习惯。
