Tips for multidisciplinary pain management in advanced dementia based on expert opinions

Although pain is one of the most common symptoms experienced by people with dementia in long-term care, there have been few studies on the actionable knowledge of pain assessment and management in dementia care from a multidisciplinary perspective. This study aimed to identify practical tips for pain management of patients with advanced dementia using a multidisciplinary approach.

Individual in-depth interviews were conducted between January and March 2022 with 24 healthcare professionals who had ample experience in primary palliative care for dementia. The qualitative data were analyzed using a qualitative content analysis.

Three main themes and nine subthemes capturing advice in pain assessment and management for advanced dementia were identified: patient assessment (early detection, multidisciplinary comprehensive assessment, drowsiness and inactivity, diagnostic therapy), assessment of family understanding of pain in dementia (willingness to accept guidance from experts, understanding and acceptance of dementia), and intervention (distraction, resistance and nonadherence to care, care-related pain).

These findings identified dementia-specific practical advice for pain management. First, multidisciplinary teams are required to better understand slight behavioral changes of people with advanced dementia. Second, they must be equipped with the necessary knowledge to differentiate symptoms of advanced dementia from those of other conditions. Third, pain medicine administration, along with a diagnostic procedure, is recommended. Fourth, distraction from chronic pain, reduced resistance and nonadherence to care were offered as pain management strategies for advanced dementia. Finally, family members must be educated about pain in those with advanced dementia because pain management was the most identified burden faced by family caregivers.