Context

Pain commonly occurs in people living with dementia but is often undertreated. Non-pharmacological interventions are a safer first-line option for pain management, but evidence-based interventions for people living with dementia have not been established. An increasing number of studies have examined the effect of non-pharmacological interventions in pain management. However, the evidence that specifically focuses on people living with dementia has not been systematically reviewed.

Objectives

This review aimed to systematically synthesize current evidence on non-pharmacological interventions to manage pain in people living with dementia.

Methods

A comprehensive search of the literature was conducted in PubMed, CINAHL, Scopus, and Web of Science databases. Studies were included if they were 1) peer-reviewed original quantitative research, 2) tested the effect of non-pharmacological interventions on pain in people with dementia, and 3) English language. Studies were excluded if they 1) included both pharmacological and non-pharmacological interventions and did not report separate results for the non-pharmacological interventions; 2) enrolled participants with and without dementia and did not have separate results reported for individuals with dementia; 3) tested dietary supplements as the intervention; and 4) were not original research, such as reviews, editorials, commentaries, or case studies. Title, abstract, and full text were screened. Quality assessment was conducted using the Cochrane Risk of Bias tool and Johns Hopkins Level of Evidence. Pain assessment tools, participant characteristics, study designs, intervention condition, and results were extracted. Results were synthesized through grouping the type of the interventions and weighting evidence based on quality and design of the studies.

Results

A total of 11 articles and 12 interventions were identified. A total of 486 participants were included. Interventions that have shown a positive impact on pain include ear acupressure, music therapy, reflexology, tailored pain intervention, painting and singing, personal assistive robot, cognitive-behavioral therapy, play activity, and person-centered environment program. Nevertheless, a majority of the interventions were only evaluated once. Moreover, most studies had similar sample characteristics and setting.

Conclusion

Overall, the quality of included studies were mostly low to mixed quality and most participants only had mild to moderate baseline pain, which limits detection of the intervention's effect. Hence, these findings need to be duplicated in studies with a greater sample size, a more diverse population (race, gender, and settings), and a more rigorous design to validate the results.

中文翻译：

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痴呆症患者疼痛的非药物干预：系统评价

语境

疼痛通常发生在痴呆症患者身上，但往往治疗不足。非药物干预是疼痛管理的更安全的一线选择，但尚未建立针对痴呆症患者的循证干预措施。越来越多的研究检验了非药物干预对疼痛管理的影响。然而，尚未系统地审查专门针对痴呆症患者的证据。

目标

本综述旨在系统地综合当前关于非药物干预措施来管理痴呆症患者疼痛的证据。

方法

在 PubMed、CINAHL、Scopus 和 Web of Science 数据库中对文献进行了全面搜索。如果研究符合以下条件，即 1) 同行评审的原始定量研究，2) 测试非药物干预对痴呆症患者疼痛的影响，以及 3) 英语语言。如果研究 1) 包括药物和非药物干预，并且没有报告非药物干预的单独结果，则将被排除在外；2) 纳入患有和不患有痴呆症的参与者，并且没有单独报告痴呆症患者的结果；3) 测试膳食补充剂作为干预；4) 不是原创研究，例如评论、社论、评论或案例研究。筛选标题、摘要和全文。使用 Cochrane 偏倚风险工具和约翰霍普金斯证据水平进行质量评估。提取疼痛评估工具、参与者特征、研究设计、干预条件和结果。根据研究的质量和设计，通过对干预类型进行分组并加权证据来综合结果。

结果

共确定了 11 篇文章和 12 项干预措施。共有 486 名参与者被包括在内。已显示出对疼痛产生积极影响的干预措施包括耳穴按摩、音乐疗法、反射疗法、量身定制的疼痛干预、绘画和唱歌、个人辅助机器人、认知行为疗法、游戏活动和以人为本的环境计划。尽管如此，大多数干预措施只评估了一次。此外，大多数研究具有相似的样本特征和设置。

结论

总体而言，纳入研究的质量大多为低质量或混合质量，大多数参与者只有轻度至中度的基线疼痛，这限制了对干预效果的检测。因此，需要在更大样本量、更多样化人群（种族、性别和环境）和更严格设计的研究中复制这些发现以验证结果。