Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
Int J Geriatr Psychiatry. 2011 Oct;26(10):1012-8. doi: 10.1002/gps.2649. Epub 2011 Feb 9.
Advancing age is associated with high prevalence of both dementia and pain. Dementia is frequently accompanied by distressing behavioral and psychological symptoms, including agitation and aggression, particularly in nursing home patients. The etiology of agitation is multifactorial. It has been suggested that un-diagnosed and untreated pain may contribute to agitation in people with dementia. If this is correct, individual pain treatment could be of benefit in ameliorating agitation and other behavioral changes in people with dementia.
The objective of this paper is to conduct a systematic review of studies of whether pain medication can improve agitation in people with dementia.
A systematic search of the PubMed and Cochrane databases for the period 1992-2010 was performed, using dementia, agitation, aggression, depression, behavioral disturbances, behavioral and psychological symptoms (BPSD), pain, pain assessment, pain treatment, pain management, and analgesics as search terms. Inclusion criteria were: prospective studies including patients with dementia, interventions focusing on pain reduction, inclusion of a control condition, and outcome measures including agitation or other related behavioral disturbances.
Only three controlled trials were identified; all were cross-over trials, and two included small sample sizes (<50). Findings were inconsistent, and although some correlations were reported, these did not support the hypothesis that pain management reduced agitation.
There is a profound dearth of rigorous studies of the effect of pain treatment in patients with dementia and agitation. The available studies do not support the hypothesis that pain management reduces agitation in nursing-home patients with dementia. Randomized, controlled parallel-group studies are needed.
随着年龄的增长，痴呆症和疼痛的患病率都很高。痴呆症常伴有痛苦的行为和心理症状，包括躁动和攻击行为，尤其是在养老院的患者中。躁动的病因是多因素的。有人认为，未诊断和未治疗的疼痛可能导致痴呆患者躁动。如果这是正确的，那么针对个体的疼痛治疗可能有助于改善痴呆患者的躁动和其他行为变化。
本文旨在对是否可以使用止痛药改善痴呆患者躁动的研究进行系统综述。
对 1992-2010 年期间的 PubMed 和 Cochrane 数据库进行了系统检索，使用痴呆、躁动、攻击、抑郁、行为障碍、行为和心理症状（BPSD）、疼痛、疼痛评估、疼痛治疗、疼痛管理和镇痛药作为检索词。纳入标准为：前瞻性研究，包括痴呆患者，干预重点是减少疼痛，包括对照条件，以及包括躁动或其他相关行为障碍的结果测量。
仅确定了三项对照试验；所有都是交叉试验，其中两项的样本量较小（<50）。研究结果不一致，尽管报告了一些相关性，但这些相关性并不支持疼痛管理可以减轻躁动的假设。
对于痴呆和躁动患者的疼痛治疗效果，缺乏严格的研究。现有的研究并不支持疼痛管理可以减轻养老院痴呆患者躁动的假设。需要进行随机、对照、平行组研究。
