Pain Treatment in Nursing Home Residents May Improve Sleep

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Patients in the intervention group received paracetamol (3 g/d) if they were not already using analgesics.
Patients in the intervention group received paracetamol (3 g/d) if they were not already using analgesics.

A stepwise pain treatment may improve sleep in patients with dementia and depression residing in nursing homes, according to the results of a recent study published in the International Journal of Geriatric Psychiatry.

In this multicenter controlled trial, 106 patients with depression and dementia in long-term nursing home care were randomly assigned to receive stepwise pain treatment or placebo. Patients in the intervention group received paracetamol (3 g/d) if they were not already receiving analgesic medication, or transdermal buprenorphine (up to 10 μg/h/7 d) if they were already receiving treatment for pain.

Sleep efficiency, sleep onset latency, awake after sleep onset, early morning awakening, and number of wake bouts were recorded by actigraphy during the week prior to treatment (baseline) and during the week-long treatment. Sleep parameters were compared between baseline and treatment periods.

Compared with the control group, the intervention group had improvements in sleep efficiency (P =.003), sleep onset latency (P =.047), and early morning awakening (P =.043). No significant differences were reported between groups for total sleep time (P =.074), waking after sleep onset (P =.604), or number of wake bouts (P =.831). The buprenorphine group had significant improvement in change in total sleep time compared with the paracetamol group (P =.016).

Improvements in sleep efficiency, sleep onset latency, and early morning awakening were similar in patients with preexisting sleep disturbances (sleep efficiency <85% at baseline) and in the general population. In addition, change in total sleep time was significantly improved for pain treatment compared with placebo in patients with sleep disturbances (P =.014).

When the analysis was restricted to patients with pain at baseline, changes in sleep between the placebo and intervention groups were not significantly different. In an interview with Clinical Pain Advisor, Kjersti Marie Blytt, PhD candidate in the department of Global Public Health and Primary Care at the University of Bergen, Norway, and lead author on the study explained that these results suggest that, “pain relief might not be the underlying mechanism that leads to better sleep [with the stepwise treatment].”

Ms Blytt concluded that, “pain treatment improved sleep as measured with actigraphy. However, the underlying mechanisms for these results are unknown. Nursing home clinicians should critically evaluate pain, sleep, and depression in nursing home patients and based on this, consider pain treatment as potentially beneficial.”

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Reference

Blytt KM, Bjorvatn B, Husebo B, Flo E. Effects of pain treatment on sleep in nursing home patients with dementia and depression: A multicenter placebo-controlled randomized clinical trial [published online December 28, 2017]. Int J Geriatr Psychiatry. doi: 10.1002/gps.4839

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