104
Informaciones
Psiquiátricas
2016 - n.º 224
Pablo A. Gallardo Schall / Romeo E. Rivas Espinoza
reducción del dolor y agitación, finalmente
Manfredi, concluyó que el grupo de mayores
de 84 años con demencia severa y tratamien-
to opioide presentó menor agitación (-6.4
en el CMAI). Sin embargo, no existe toda-
vía un consenso que haya brindado un alto
grado de recomendación por ser la evidencia
escasa y no poder generalizar los resultados
en varios contextos clínicos. Lo que motiva a
la realización de nuevos ensayos controlados
aleatorizados, y herramientas de evaluación
del dolor para evaluar la eficacia en el con-
trol de síntomas neuropsiquiátricos.
Palabras clave:
Dolor en demencia, instru-
mentos de evaluación del dolor, control de
síntomas psicológicos y conductuales.
Abstract
Introduction.
One half of patients with
dementia suffer from pain, which can trigger
neuropsychiatric symptoms, and pain is un-
derdiagnosed and undertreated in patients
with dementia.
Objective. Review of the pathophysiology
of pain in dementia, pain assessment instru-
ments, observational studies and randomized
controlled trials (RCTs) of pain treatment in
moderate to severe dementia to assess their
effectiveness in controlling behavioral and
psychological symptoms.
Methodology.
A systematic search of ME-
DLINE / COCHRANE that included 38 articles:
pathophysiology of pain in dementia, as-
sessment tools, treatment of pain in demen-
tia and effectiveness in controlling neurop-
sychiatric symptoms.
Discussion and conclusions.
Aging is
associated with a decreased threshold and
lower tolerance to pain, however in patients
with Alzheimer’s disease, there is no varia-
tion in the threshold and on the contrary
there is an increased tolerance. In advan-
ced dementia, the method of choice for as-
sessing pain constitutes the instrument of
direct observation of behaviour. Systema-
tic reviews (Corbett and Lichtner) conclude
that there is no tool with all appropriate
psychometric properties and clinical utility;
although DOLOPLUS 2, MOBID2, and PACSLAC
have moderate psychometric characteristics,
they don’t have clinical utility in several cli-
nical settings and population groups. RCTs
show controversial results, trials that shows
effectiveness in controlling neuropsychiatric
symptoms include Husebo’s trial with the lar-
ge sample size (n = 352), using non-opioid
analgesics and opioid shows reduction in
agitation and neuropsychiatric symptoms
severity. In secondary analyzes evidenced
decrease in verbal aggression, wandering,
apathy and altered appetite; Chapman and
Toseland used pharmacological and non-
pharmacological measures getting reduced
pain and agitation, finally Manfredi conclu-
ded that the group over 84 years with severe
dementia and opioid treatment showed less
agitation (-6.4 in CMAI). However, there is
still no consensus that has provided a high
degree of recommendation because of the
little evidence and has not allowed genera-
lize the results in various clinical settings.
What motivates conduct further randomized
controlled trials, and pain assessment tools
to evaluate the effectiveness in controlling
neuropsychiatric symptoms.
Key words:
Pain in dementia, instruments for
pain assessment, management of behavioral
and psychological symptoms.
