Interactive, Nonpharmacologic Interventions May Improve Pain Management in Dementia

Nonpharmacologic interventions such as singing, painting, massage, ear acupressure, and listening to music may reduce pain or tend to reduce pain in patients with dementia, according to study findings published in the Journal of Clinical Nursing.

Researchers from Ireland conducted a mixed-methods systematic review of research publications from January 2009 to February 2020 to summarize the evidence on nonpharmacologic pain management interventions in patients with dementia. Studies included in the review were those conducted in any care setting, including community, family, hospital, nursing home, long-term care facility, or outpatient facility settings.

In total, 8 studies met the inclusion criteria, including 6 randomized controlled studies, 1 quasi-experimental study, and 1 qualitative descriptive study. Overall, patients were aged more than 60 years. Nonpharmacologic interventions included ear acupressure, play activities program, therapeutic robots, massage, music, and painting. Nurses supervised all interventions in these studies, while some activities, including painting and music activities, were provided by professional therapists. In 1 study, however, family members played music for patients in the patients’ homes.

Across all studies, the most common nonpharmacologic intervention used for pain management was massage. Despite the widescale use of massage, the researchers noted that the play activities program represented the most effective intervention for pain management. They added that all studies showed evidence supporting an effect of nonpharmacological interventions on pain management in patients with dementia or suggested nonpharmacologic interventions tended to reduce pain in these patients. Additionally, interactive interventions, such as singing and play activities, were considered more effective than noninteractive interventions (e.g., receiving a massage) for pain management. The researchers noted that the quality of the studies included in the review was strong.

Limitations included the small number of studies as well as the limited sample sizes of some of the studies’ cohorts.

The choice of a nonpharmacologic intervention for pain management in patients with dementia “should be considered by combining personality in the course of patient care because different results were found in massages or by using music,” the researchers stated. Likewise, nurses supervising these programs “should consider the content and/or duration of non-pharmacological interventions, including delivery patterns, and they should be adjusted according to the patient’s personal preferences and living settings and furthermore incorporated into daily clinical practice, which may improve the degree of completion and compliance of interventions,” they concluded.

Reference

Bao Z, Landers M. Non-pharmacological interventions for pain management in patients with dementia: A mixed-methods systematic review. J Clin Nurs. Published online July 12, 2021. doi:10.1111/jocn.15963