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Pain Relievers Present Special Hazards in People With Alzheimer’s Disease

People with Alzheimer’s disease and other forms of dementia were especially likely to suffer from harmful side effects from commonly prescribed opioid pain medications, according to a new report. Another study carried out on mice suggests that Alzheimer’s patients may be particularly sensitive to the drugs and may get effective pain relief from lower, and safer, doses.

Around half of people with dementia who are living in nursing homes experience clinically significant pain. The findings suggest that doctors should take extra care on dosing for pain relief in people with Alzheimer’s disease or other forms of dementia.

For one of the studies, researchers from the University of Exeter, King’s College London and the University of Bergen looked at 162 Norwegian men and women with dementia who were living in nursing homes. They found that among patients with advanced dementia, opioid pain relievers were three times more likely to? cause such side effects as personality changes, confusion and sedation. Such side effects can impair a person’s ability to carry out daily activities and lead to potentially harmful, even fatal, falls.

“Pain is a symptom that can cause huge distress, and it’s important that we can provide relief to people with dementia,” said Clive Ballard, a study author and a professor of age-related diseases at the University of Exeter Medical School. “Sadly, at the moment, we’re harming people when we’re trying to ease their pain. We need to examine appropriate dosing for people with dementia.” The findings were presented at the Alzheimer’s Association International Conference.

Earlier studies have demonstrated that pain is often under-diagnosed and poorly managed in people with dementia, diminishing patients’ quality of life. While many patients are treated with gentler pain relievers like Tylenol, doctors prescribe opioids to up to 40 percent of patients living in nursing homes.

While the drugs can effectively ease pain, current prescribing guidelines do not take into account the fact that people with dementia often get effective pain relief from lower doses than are commonly prescribed, the authors note. Such patients may also be particularly sensitive to adverse effects.

In a separate study also presented at the conference, researchers reported that mice that had been specially bred to develop arthritis and a disease resembling Alzheimer’s in people were particularly sensitive to opioid medication. The arthritic mice responded to much lower doses of the opioid drugs, and experienced more adverse side effects when they were given typical doses of the drugs. The researchers found that the animals’ brains produced more of the natural pain relievers that mimic the effects of opioid medications.

The authors note that doctors who are prescribing pain relievers to people with dementia take special care in providing the lowest effective dose in order to help prevent unnecessary harm.

By ALZinfo.org, The Alzheimer’s Information Site. Reviewed by Marc Flajolet, Ph.D., Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University.

Sources: Ane Erdal, Elisabeth Flo, Dag Aarsland, et al: “A Randomized, Placebo-Controlled Trial to Investigate Safety in People with Dementia or Buprenorphine Transdermal System for Pain Management.” Poster session presented at the Alzheimer’s Association International Conference July 24, 2018

Yahyah Aman, Thomas Pitcher, Clive Ballard, Marzia Malcangio: “Impaired chronic pain-like behaviour and disruption of opioidergic system in TASTPM model of Alzheimer’s disease.” Poster session presented at the Alzheimer’s Association International Conference, July 23, 2018.

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