Treating Chronic Pain in Dementia Patients

Treating Chronic Pain in Dementia Patients

The U.S. population is steadily getting older, and that means that health issues like chronic pain and dementia will become more widespread.  Due to improving health care, more Americans are living longer which means that the risk of developing a serious pain or a neurological condition is more likely. As these risks increase in the general population, more people are having to struggle with both kinds of health issues simultaneously.

Estimates suggest that pain lasting more than three months may be present in up to 50 percent of the senior population, while the number of seniors with dementia range from five to eight percent.  Although it is unclear how many of the elderly suffer from both conditions, there is likely to be a significant population because recent studies suggest that there is a causal link between chronic pain and cognitive dysfunction.

What Is Dementia?

Almost everyone experiences some decline in cognitive abilities like memory, speech or problem solving as they age, but there is a stark contrast between weakening cognitive function and the medical concept of dementia. Dementia is not a single ailment but includes an entire class of neurological diseases. By definition, all of these illnesses cause abnormal brain changes that interfere with independent daily life.

Dementia includes the following conditions:

• Alzheimer’s disease—almost 60 to 80 percent of dementia patients suffer from Alzheimer’s disease.
• Vascular dementia—the second most common form of dementia involves microscopic bleeding and blood vessel blockages in the brain.
• Lewy body dementia—this kind of dementia results from abnormal protein deposits on nerve cells which can lead to memory loss, disorientation, insomnia and hallucinations.
• Frontotemporal dementia—this mysterious illness affects the frontal and temporal regions of the brain and produces loss of inhibition, compulsive behaviors and speech impairment.
• Normal pressure hydrocephalus—excess fluid accumulation in the brain’s ventricles can place pressure on brain tissue, killing cells and producing dementia symptoms.

Certain environmental stresses like multiple concussions or substance abuse may also produce dementia. Although progress is being made in the treatment of many of these kinds of dementia, there is currently no way to reverse the damage to the brain that is typically involved (there is some chance of recovery for substance-related dementia).  

There is no cure for most forms of dementia, but it is possible to manage the symptoms. There is usually a dual approach to treating dementia that involves a pharmacological therapy combined with occupational therapy.

Treating Chronic Pain to Help Prevent Dementia

It is not surprising that there are many seniors who suffer from dementia as well as chronic pain, due to the prevalence of both conditions in this demographic. However, new research suggests that the occurrence of chronic pain may elevate the risk of dementia. A study that examined 10,000 medical histories over a 12-year period found that those with chronic pain had a 9.2 percent higher risk of declining memory function than those without pain symptoms.

Although the nature of this causal link is not yet understood—it has been theorized that opioid medications may damage brain cells or that persistent pain can compromise brain function—it is probable that there is some kind of relationship that makes pain management even more of an imperative.  An effective pain therapy may help safeguard brain function later in life.

However, it should be understood that this is emerging research and that the scientific results still need additional evidence to support them. There may be, in fact, a real link between chronic pain and dementia, but it is unlikely to be as strong as the link between dementia and diabetes or other health conditions. In the case of diabetes, there is a 73 percent higher chance of developing vascular dementia.

Chronic Pain Treatments for Seniors

Patients with dementia present additional challenges for pain physicians but implementing an effective pain management plan can be achieved. These challenges include

• Higher likelihood of inflating pain symptom intensity
• May describe pain symptoms in imprecise or inconsistent terms
• May have impaired communication skills
• Multiple drug regimens may cause complications
• Seniors may be more sensitive to side effects

The most commonly recommended pain therapies for seniors with dementia include:

• Physical therapy—this active form of pain treatment can produce health dividends in a number of ways. Not only can physical exercise help produce enduring symptom relief via strengthening and increased flexibility, but it produces an immediate pain relief and emotional boost that can help encourage independent physical activity.
• Yoga—this low-impact form of exercise is often recommended for chronic pain patients because it improves strength and flexibility as well as mental state. This form of exercise emphasizes spiritual peace through controlled breathing and meditation that has helped many seniors better manage their pain.
• Pain medications—because of physical or mental infirmities in many seniors, that can make physical activity very difficult, medications are most often used to treat pain in dementia patients. Although opioids are used in some situations, they are used less often due to side effects and the risk of addiction. More commonly, doctors recommend NSAIDs like aspirin or Tylenol.
• Cognitive Behavioral Therapy—CBT has proven an effective pain management technique that can help modify physical and psychological responses to pain. This can help alleviate anxiety and depression which may reinforce pain symptom severity.  In addition to counseling, CBT may also use various techniques like biofeedback or guided imagery to help patients mentally dissociate from pain symptoms.
• Myofascial release—these techniques may be performed by chiropractors, pain specialists or physical therapists and involve pressure application to myofascial trigger points.  These trigger points found in muscles help release tension resulting from pain symptoms. The use of myofascial release can diminish pain, lower anxiety and depression and improve sleep.
• Acupuncture—although this technique has been used for centuries in Asian cultures, it is only now gaining approval in Western medicine.  Due to the minimal risks involved in acupuncture—light bleeding or nerve pain—more physicians are recommending that their patients at least give it a try.

Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care

M.D. Disclaimer: The views expressed in this article are the personal views of Robert Moghim, M.D. and do not necessarily represent and are not intended to represent the views of the company or its employees.  The information contained in this article does not constitute medical advice, nor does reading or accessing this information create a patient-provider relationship.  Comments that you post will be shared with all visitors to this page. The comment feature is not governed by HIPAA and you should not post any of your private health information.