Analgesics use and withdrawal in people with dementia: a register-based Danish study and a systematic review
Research output: Contribution to journal › Review › Research › peer-review
Documents
- a5578_3
Final published version, 602 KB, PDF document
INTRODUCTION: Pain assessment in people with dementia is difficult, and withdrawal of analgesics may allow for assessment of treatment efficacy whilst decreasing pill burden, adverse events and interactions. We aimed to describe the use of analgesics among elderly in Denmark and to compile the evidence for withdrawal of analgesics among people with dementia.
METHODS: With respect to analgesics use, we employed data from national registries on the analgesic prescription use (opioids, nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen) in 2017 among elderly people with and without dementia. Trial evidence was produced by performing a systematic search in MEDLINE, Embase and Cinahl for trials evaluating withdrawal of analgesics in people with dementia.
RESULTS: Opioids were prescribed more frequently (p = 0.026) and NSAIDs less frequently (p = 0.026) to people with dementia. With respect to trial evidence, we identified two studies: An observational cross-over study (n = 3) reporting acetaminophen withdrawal leading to increases in pain frequency and duration, and a cluster-randomised clinical trial (n = 352) reporting changes in mobilization-observation-behaviour-intensity-dementia-2 (MOBID-2) pain score during a four-week withdrawal period (acetaminophen, opioids and/or pregabaline) from a mean ± standard deviation of 2.3 ± 2.1 to 2.9 ± 2.6 compared with 3.5 ± 2.6 to 3.5 ± 2.5 in the control group.
CONCLUSIONS: In Denmark, use of opioids is higher in elderly with dementia compared to elderly without dementia. The evidence suggests that withdrawal of analgesics may aggravate pain but increases in pain scores may be of little clinical relevance in most people. Clinical trials investigating analgesics withdrawal are warranted.
Original language | English |
---|---|
Article number | A5578 |
Journal | Danish Medical Journal |
Volume | 66 |
Issue number | 12 |
Number of pages | 6 |
ISSN | 1603-9629 |
Publication status | Published - 2019 |
- Acetaminophen/therapeutic use, Aged, Aged, 80 and over, Analgesics, Non-Narcotic/therapeutic use, Analgesics, Opioid/therapeutic use, Anti-Inflammatory Agents, Non-Steroidal/therapeutic use, Case-Control Studies, Dementia/complications, Denmark, Deprescriptions, Drug Utilization/statistics & numerical data, Female, Humans, Male, Middle Aged, Pain/complications, Registries
Research areas
Links
- https://ugeskriftet.dk/files/scientific_article_files/2019-11/a5578_3.pdf
Final published version
Number of downloads are based on statistics from Google Scholar and www.ku.dk
ID: 241276552