title: Pain treatment of agitation in patients with dementia: a systematic review.
abstract: BACKGROUND
  Advancing age is associated with high prevalence of both dementia and pain. Dementia is frequently accompanied by distressing behavioral and psychological symptoms, including agitation and aggression, particularly in nursing home patients. The etiology of agitation is multifactorial. It has been suggested that un-diagnosed and untreated pain may contribute to agitation in people with dementia. If this is correct, individual pain treatment could be of benefit in ameliorating agitation and other behavioral changes in people with dementia.
  
  
  OBJECTIVE
  The objective of this paper is to conduct a systematic review of studies of whether pain medication can improve agitation in people with dementia.
  
  
  METHODS
  A systematic search of the PubMed and Cochrane databases for the period 1992-2010 was performed, using dementia, agitation, aggression, depression, behavioral disturbances, behavioral and psychological symptoms (BPSD), pain, pain assessment, pain treatment, pain management, and analgesics as search terms. Inclusion criteria were: prospective studies including patients with dementia, interventions focusing on pain reduction, inclusion of a control condition, and outcome measures including agitation or other related behavioral disturbances.
  
  
  RESULTS
  Only three controlled trials were identified; all were cross-over trials, and two included small sample sizes (<50). Findings were inconsistent, and although some correlations were reported, these did not support the hypothesis that pain management reduced agitation.
  
  
  CONCLUSIONS
  There is a profound dearth of rigorous studies of the effect of pain treatment in patients with dementia and agitation. The available studies do not support the hypothesis that pain management reduces agitation in nursing-home patients with dementia. Randomized, controlled parallel-group studies are needed.
authors.affiliation: Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway. bettina.husebo@isf.uib.no
authors.forename: B S
authors.initials: BS
authors.lastname: Husebo
authors.forename: C
authors.initials: C
authors.lastname: Ballard
authors.forename: D
authors.initials: D
authors.lastname: Aarsland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D003704:Dementia / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy*; D011595:Psychomotor Agitation / Q000188:drug therapy* / Q000209:etiology; D016032:Randomized Controlled Trials as Topic
chemical_list: D000700:Analgesics