Vanderbilt University School of Nursing, Nashville, Tennessee.
University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado.
Pain Manag Nurs. 2021 Feb;22(1):3-7. doi: 10.1016/j.pmn.2020.06.005. Epub 2020 Jul 16.
Untreated pain in people with Alzheimer's disease continues to be a serious public health problem. Pain is a subjective and complex experience that becomes increasingly challenging to assess as cognition declines. Our understanding of pain processing is incomplete, particularly for special populations such as people living with Alzheimer's disease, and especially in the advanced stages of the disease. Pain-processing networks in the brain are altered in Alzheimer's disease, yet evidence suggests people living with Alzheimer's disease do not experience less pain. Rather, their pain is not adequately recognized or treated. Although scholarly publications provide important assistance, recent widespread reports and guidelines do not include sufficient guidance, especially as Alzheimer's disease progresses to the last stages. Additionally, current pain measurements may not accurately evaluate pain in this condition, and the existing definitions of pain are not adequate when considering the effects of Alzheimer's disease on pain-processing in the brain. There is a need for new, widespread policies, guidelines, and definitions to help clinicians adequately manage pain in people with Alzheimer's disease. These will need to hinge on continued research because it remains unclear how Alzheimer's disease impacts central pain processing, pain expression, and communication of pain. In the meantime, policies and guidelines need to highlight current best practices as well as the fact that pain continues in Alzheimer's disease.
未经治疗的阿尔茨海默病患者的疼痛仍然是一个严重的公共卫生问题。疼痛是一种主观且复杂的体验，随着认知能力的下降，评估起来越来越具有挑战性。我们对疼痛处理的理解并不完整，特别是对于阿尔茨海默病等特殊人群，尤其是在疾病的晚期。阿尔茨海默病患者大脑中的疼痛处理网络发生改变，但有证据表明，他们的疼痛并没有减轻，而是没有得到充分的识别或治疗。尽管学术出版物提供了重要的帮助，但最近的广泛报道和指南并没有提供足够的指导，尤其是在阿尔茨海默病进展到最后阶段时。此外，目前的疼痛测量方法可能无法准确评估这种情况下的疼痛，而且现有的疼痛定义在考虑阿尔茨海默病对大脑疼痛处理的影响时并不充分。需要制定新的、广泛的政策、指南和定义，以帮助临床医生在阿尔茨海默病患者中妥善管理疼痛。这将需要依靠持续的研究，因为目前仍不清楚阿尔茨海默病如何影响中枢疼痛处理、疼痛表达以及疼痛的传递。与此同时，政策和指南需要强调当前的最佳实践，以及阿尔茨海默病患者持续存在疼痛的事实。
