In a new study, researchers found that the treatment and management of pain in people with Alzheimer’s disease (AD) can be a challenge due to problems in communication and uncommon symptoms of pain.
Opioid painkillers are widely prescribed, but not without adverse effects.
The research was conducted by a team at the University of Eastern Finland.
Pain is commonly reported by older people regardless of whether they have Alzheimer’s or not.
However, AD makes things more complicated, as there are frequent problems in communication and people may express their pain through behavioral and psychiatric symptoms.
Indeed, antipsychotics, anti-anxiety drugs, and sleep-inducing drugs are often prescribed to people with AD, sometimes in response to their symptoms of pain.
Finding the best course of treatment to alleviate pain in people with Alzheimer’s disease is a complex and multifaceted issue.
In the study, the team used data from national health care registers to examine the use of opioids and other painkillers in more than 70,000 people diagnosed with AD in Finland.
They found that when people with AD were prescribed an opioid analgesic, the use of antipsychotics and benzodiazepine drugs began to decrease.
People with Alzheimer’s disease are prescribed an opioid almost as frequently as people without AD. There are, however, differences in how opioids are used.
Pills are often replaced by opioid skin patches, whose effect can last up to several days.
Long-term use is also common in people with AD: once an opioid is started, more than 30% continue using them for six months or more.
The team says long-term use of opioids can be problematic, as adverse effects may occur. In any case, regular assessment of pain and opioid use is important in all patients, those with and without cognitive disorders alike.
While opioids may alleviate pain and other possible pain induced symptoms in people with AD, they also increase the risk of pneumonia by around 30%.
Strong opioids such as oxycodone and fentanyl increase the risk most, but an increased risk was also found among those using buprenorphine, tramadol or codeine.
Treating pain in older people with drugs, especially long-term, is always a balancing act, the researchers suggest.
The lead author of the study is Researcher Aleksi Hamina, MSc (Pharm.)
The study is published in the European Journal of Pain, PAIN, International Psychogeriatrics, and Journal of Alzheimer’s Disease.
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