Pain and Dementia

People with dementia (PwD) constitute a growing group of older adults who are likely to experience pain from complex chronic conditions, including musculoskeletal and neuropathic conditions, cardiac and pulmonary disease, and cancer. Although the prevalence of painful conditions in this population remains high, report of pain is less than in older adults without cognitive impairment. The cognitive decline occurring in those with dementia affects their ability to communicate the pain experience and its impact effectively. Improved understanding of the physiological changes occurring in PwD can help inform interpretation of pain behaviors and the pain experience. A broad approach to recognizing pain in affected individuals has been proposed that includes self-report when possible, identification of potential painful conditions, observation of behaviors indicative of pain, elicitation of surrogate input, and use of an analgesic trial to validate pain presence, if necessary. Numerous behavior pain scales have been developed to advance pain recognition and monitoring, and ongoing work is needed to refine and support consistent use of these measures in practice. Differentiating pain in persons with comorbidities that exhibit similar behavior patterns has been a challenge (e.g. mood, agitation, psychosis). Innovative approaches to identify pain in this population continue to evolve, including facial recognition techniques, use of imaging techniques, and other biomarkers. Persons with dementia are often excluded from research on interventions, thereby limiting the evidence base for selecting and adapting pain treatments, including engagement of surrogate caregivers in the assessment and treatment of pain.

The aim of the current Research Topic is to cover recent, promising, and novel research trends in addressing pain in PwD. Areas to be covered in this Research Topic may include, but are not limited to:

1. Impact of physiological brain changes on perception and experience of pain
2. Effective approaches for identifying and quantifying pain in PwD and its impact
3. Treatment challenges with over- and under-treatment and non-pharmacological interventions
4. Evidence-based strategies for treatment of pain in dementia, including analgesic and nonpharmacologic interventions
5. Strategies to improve care of PwD across care setting and providers
6. Engagement and preparation of family caregivers to support pain care in PwD

This series of papers seeks to represent the most recent conceptual and empirical advances in the important and rapidly advancing field of pain assessment and management in PLWD. We invite both reviews of the literature and research investigations advancing the field.