Volume 44 Number 2 2007
Pages 315 — 330

Abstract - Cognitive impairment and pain management: Review of issues and challenges

Martha D. Buffum, DNSc, APRN, BC, CS;1-2* Evelyn Hutt, MD;3-4 Victor T. Chang, MD;5-6 Michael H. Craine, PhD;3-4 A. Lynn Snow, PhD7

1Department of Veterans Affairs (VA) Medical Center (VAMC), San Francisco, CA; 2School of Nursing, University of California, San Francisco, CA; 3VA Eastern Colorado Health Care System/Denver VAMC, Denver, CO; 4University of Colorado at Denver and Health Sciences Center, Denver, CO; 5VA New Jersey Health Care System at East Orange, East Orange, NJ; 6University of Medicine and Dentistry of New Jersey, Newark, NJ; 7University of Alabama, Tuscaloosa, AL

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.

Key words: amnestic, analgesia, cognitive disorders, delirium, dementia, intensive care, nursing homes, pain, pain measurement, palliative care.

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