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Non-pharmacological interventions for pain management in patients with dementia: A mixed-methods systematic review.

AIMS AND OBJECTIVES
To systematically identify, summarise and compare evidence from studies related to the non-pharmacological interventions used to manage pain in patients with dementia. Secondly, this study aims to provide evidence on the effectiveness of non-pharmacological interventions used to manage pain in patients with dementia.


BACKGROUND
The number of people diagnosed with dementia is rising rapidly in the context of ageing. Pain is considered to be one of the most common neuropsychiatric symptoms of dementia. To date, little research has focused on non-pharmacological interventions to manage pain in patients with dementia. Therefore, a systematic review on the non-pharmacological interventions used to manage pain in patients with dementia and how effective these interventions are, is warranted.


METHOD
The extensive search strategy included electronic database searches for CINAHL, MEDLINE and PsycINFO from January 2009 to February 2020. A mixed-methods systematic review was undertaken in accordance with the PRISMA statement and relevant papers were chosen based on inclusion criteria and quality assessment measures. Eligibility criteria defined the characteristics of inclusion studies using the PICO framework. Results were extracted to a synthesis table. The quality appraisal was conducted using JBI and CASP checklist.


RESULTS
Eight studies met the inclusion criteria. These included six randomised controlled trials, one quasi-experimental study and one qualitative descriptive study. The current review identified various non-pharmacological interventions for pain management in patients with dementia including singing, painting, massage, ear acupressure, play activities program and robot. The most common intervention was massage while the most effective intervention was play activities program. All studies provided evidence that non-pharmacological interventions have an effect on pain management in patients with dementia or that there was a tendency for non-pharmacological intervention to reduce pain in patients with dementia. Overall, the quality of the included studies was interpreted as strong (n = 8).


CONCLUSIONS
Overall, interactive pharmacological interventions were more effective than non-interactive non-pharmacological interventions. While this review highlighted a limited number of studies investigating the use of non-pharmacological interventions to manage pain in patients with dementia, it did however uncover a range of non-pharmacological interventions used to manage pain in these patients along with their level of effectiveness.


RELEVANCE TO CLINICAL PRACTICE
Further research is required to explore which non-pharmacological interventions are most effective in the management of pain in patients with varying degrees of cognitive impairment. Further qualitative research is also needed to explore nurses' views on the use of non-pharmacological interventions to manage pain in patients with dementia.