Pain management in dementia: so far, not so good

Pain is highly prevalent in the aging population. Individuals with neurological disorders such as dementia are susceptible patient groups in which pain is frequently under-recognised, underestimated, and under-treated. The inability to successfully communicate pain in moderate-severe dementia is a major barrier to effective treatment and several observational studies indicate that pain is under-treated among cognitively impaired elderly people. Pain has been related to neuropsychiatric symptoms in dementia, such as agitation, aggression, mood syndrome and sleep problems. Adequate pain management has been demonstrated as possibly effective in mediating or alleviating those symptoms. Recent guidelines ( American Geriatric Society 2009, British Geriatric Society 2013) recommend a comprehensive, disease-specific assessment to determine appropriate treatment for each individual. Whereas in old patients data on pain management are becoming more consistent, we still lack clinical evidence in those affected by dementia. In this narrative review, we summarize the best-available evidence regarding the aetiology, assessment and treatment of pain in people with dementia. Further large-scale trials of treatment approaches in people with dementia are needed to improve clinical guidance for the diagnosis and treatment of pain in these fragile individuals.