Hoffmann Falk, van den Bussche Hendrik, Wiese Birgitt, Glaeske Gerd, Kaduszkiewicz Hanna
Centre for Social Policy Research, Division Health Economics, Health Policy and Outcomes Research, University of Bremen, Postfach 33 04 40, D-28334 Bremen, Germany.
BMC Geriatr. 2014 Feb 12;14:20. doi: 10.1186/1471-2318-14-20.
The evidence of undertreatment of pain in patients with dementia is inconsistent. This may largely be due to methodological differences and shortcomings of studies. In a large cohort of patients with incident dementia and age- and sex-matched controls we examined (1) how often they receive diagnoses indicating pain, (2) how often they receive analgesics and (3) in which agents and formulations.
Using health insurance claims data we identified 1,848 patients with a first diagnosis of dementia aged ≥ 65 years and 7,385 age- and sex-matched controls. We analysed differences in diagnoses indicating pain and analgesic drugs prescribed between these two groups within the incidence year. We further fitted logistic regression models and stepwise adjusted for several covariates to study the relation between dementia and analgesics.
On average, patients were 78.7 years old (48% female). The proportions receiving at least one diagnosis indicating pain were similar between the dementia and control group (74.4% vs. 72.5%; p = 0.11). The proportion who received analgesics was higher in patients with dementia in the crude analysis (47.5% vs. 44.7%; OR: 1.12; 95% CI: 1.01-1.24), but was significantly lower when adjusted for socio-demographic variables, care dependency, comorbidities and diagnoses indicating pain (OR: 0.78; 95% CI: 0.68-0.88). Analgesics in liquid form such as metamizole and tramadol were more often used in dementia.
Our findings show a comparable documentation of diagnoses indicating pain in persons with incident dementia compared to those without. However, there still seems to be an undertreatment of pain in patients with dementia. Irrespective of dementia, analgesics seem to be more often prescribed to sicker patients and to control pain in the context of mobility.
痴呆患者疼痛治疗不足的证据并不一致。这可能主要归因于研究方法的差异和缺陷。在一大群新发痴呆患者以及年龄和性别匹配的对照组中，我们研究了：（1）他们被诊断出疼痛的频率；（2）他们接受镇痛药治疗的频率；（3）使用的药物种类和剂型。
利用医疗保险理赔数据，我们识别出1848例首次诊断为痴呆且年龄≥65岁的患者以及7385例年龄和性别匹配的对照。我们分析了这两组在发病年份内疼痛诊断和所开镇痛药之间的差异。我们进一步拟合逻辑回归模型，并逐步对几个协变量进行调整，以研究痴呆与镇痛药之间的关系。
患者平均年龄为78.7岁（48%为女性）。痴呆组和对照组中至少有一项疼痛诊断的比例相似（74.4%对72.5%；p = 0.11）。在粗分析中，痴呆患者接受镇痛药治疗的比例更高（47.5%对44.7%；OR：1.12；95%CI：1.01 - 1.24），但在对社会人口统计学变量、护理依赖、合并症和疼痛诊断进行调整后，该比例显著降低（OR：0.78；95%CI：0.68 - 0.88）。在痴呆患者中，更常使用液体剂型的镇痛药，如安乃近和曲马多。
我们的研究结果表明，与无痴呆者相比，新发痴呆者疼痛诊断的记录情况相当。然而，痴呆患者的疼痛似乎仍未得到充分治疗。无论是否患有痴呆，镇痛药似乎更常被开给病情较重的患者，以及用于控制行动不便情况下的疼痛。
