Beach Paul A, Huck Jonathan T, Miranda Melodie M, Bozoki Andrea C
Michigan State University College of Osteopathic Medicine, DO/PhD Training Program, East Lansing, Michigan, USA.
Michigan State University Neuroscience Program, East Lansing, Michigan, USA.
Pain Med. 2015 Oct;16(10):1930-42. doi: 10.1111/pme.12769. Epub 2015 Apr 30.
To compare autonomic, behavioral, and subjective pain responses of patients with Alzheimer's disease (AD) to those of healthy seniors (HS). As few studies have examined patients with severe Alzheimer's disease (sAD), we emphasized inclusion of these patients together with mild/moderate Alzheimer's disease (mAD) patients to characterize pain responses potentially affected by disease severity.
A controlled cross-sectional study involving repeated measures behavioral pain testing.
An outpatient clinical setting and local nursing facilities.
Community dwelling HS controls (N = 33) and individuals with chart-confirmed diagnoses of AD (N = 38, Diagnostic and Statistical Manual-IV criteria).
HS and AD groups were compared in their responses to repeated applications of five pressure intensities (1-5 kg) on the distal forearm. Autonomic responses (heart rate [HR]), pain behaviors (vocal, facial, and bodily as scored by the Pain Assessment in Advanced Dementia [PAINAD] scale), and subjective pain ratings (Faces Pain Scale-Revised) were measured.
HR responses to pressure stimuli were differentially affected based on AD severity: sAD patients had generally decreased HR reactivity compared with other groups (P < 0.01). In contrast, pain behaviors were increased in AD regardless of severity (P < 0.001), compared with HS, for all but the lowest pressure intensity. Increased behaviors occurred in all measured domains of the PAINAD (P < 0.005). While sAD were unreliable subjective reporters, mAD patients (N = 17) rated low level pressures as more painful than HS (P < 0.01).
These findings provide behavioral and subjective-report evidence of increased acute pain sensitivity in AD, which should be taken into consideration with respect to pain management across the spectrum of AD severity.
比较阿尔茨海默病（AD）患者与健康老年人（HS）的自主神经、行为和主观疼痛反应。由于很少有研究对重度阿尔茨海默病（sAD）患者进行检查，我们强调纳入这些患者以及轻度/中度阿尔茨海默病（mAD）患者，以表征可能受疾病严重程度影响的疼痛反应。
一项涉及重复测量行为疼痛测试的对照横断面研究。
门诊临床环境和当地护理机构。
社区居住的HS对照组（N = 33）和经病历确诊为AD的个体（N = 38，符合《精神疾病诊断与统计手册》第四版标准）。
比较HS组和AD组对在前臂远端重复施加五种压力强度（1 - 5千克）的反应。测量自主神经反应（心率[HR]）、疼痛行为（通过晚期痴呆疼痛评估[PAINAD]量表对声音、面部和身体进行评分）和主观疼痛评分（面部疼痛量表修订版）。
基于AD严重程度，对压力刺激的HR反应受到不同影响：与其他组相比，sAD患者的HR反应性普遍降低（P < 0.01）。相比之下，除最低压力强度外，AD患者无论严重程度如何，与HS相比疼痛行为均增加（P < 0.001）。PAINAD所有测量领域的行为均增加（P < 0.005）。虽然sAD患者作为主观报告者不可靠，但mAD患者（N = 17）将低水平压力评为比HS更疼痛（P < 0.01）。
这些发现提供了AD患者急性疼痛敏感性增加的行为和主观报告证据，在AD严重程度范围内的疼痛管理方面应予以考虑。
