title: Cognitive impairment and pain management: review of issues and challenges.
abstract: The assessment and treatment of pain in persons with cognitive impairments pose unique challenges. Disorders affecting cognition include neurodegenerative, vascular, toxic, anoxic, and infectious processes. Persons with memory, language, and speech deficits and consciousness alterations are often unable to communicate clearly about their pain and discomfort. Past research has documented that persons with cognitive impairments, particularly dementia, are less likely to ask for and receive analgesics. This article provides an overview of the assessment, treatment, and management of pain in adults with cognitive impairments. We review types of cognitive impairment; recent work specific to best practices for pain management in patients with dementia, including assessment-tool development and pharmacological treatment; challenges in patients with delirium and in medical intensive care and palliative care settings; and directions for future research.
authors.affiliation: Department of Veterans Affairs (VA) Medical Center (VAMC), 4150 Clement St (118), San Francisco, CA 94121, USA. Martha.Buffum@va.gov
authors.forename: Martha D
authors.initials: MD
authors.lastname: Buffum
authors.forename: Evelyn
authors.initials: E
authors.lastname: Hutt
authors.forename: Victor T
authors.initials: VT
authors.lastname: Chang
authors.forename: Michael H
authors.initials: MH
authors.lastname: Craine
authors.forename: A Lynn
authors.initials: AL
authors.lastname: Snow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000150:complications*; D003704:Dementia / Q000150:complications*; D019317:Evidence-Based Medicine; D016330:Frail Elderly; D006801:Humans; D010146:Pain / Q000175:diagnosis* / Q000523:psychology; D059408:Pain Management; D010147:Pain Measurement; D010166:Palliative Care; D014728:Veterans