Treatment for chronic pain in Alzheimer's disease?

From the Research

Treatment Options for Chronic Pain in Alzheimer's Disease

• Acetylcholinesterase inhibitors (AChE-Is) such as neostigmine and rivastigmine have been proven to be an efficient therapeutic resource for significant improvement in dementia of Alzheimer's disease and chronic pain 1
• Rivastigmine has been approved for the management of dementia of mild to moderate Alzheimer's disease and has gained approval for treating different types of non-Alzheimer's dementia 1
• The endocannabinoid system has been identified as a potential target for the treatment of chronic pain in Alzheimer's disease 2
• Non-pharmacological and pharmacological strategies are used to treat pain in elderly with cognitive decline or dementia, considering physiological changes, high comorbidity, and drug interactions that occur frequently in the elderly 3
• Stepped treatment approaches and pain and behavioral interventions have been shown to be beneficial in managing chronic pain in dementia 4

Challenges in Managing Chronic Pain in Alzheimer's Disease

• The presence of pain in elderly persons with cognitive decline is often neglected, under-reported, underestimated, misdiagnosed, and not adequately treated 3
• Self-assessment scales are considered the "gold standard" for pain assessment, but the presence of cognitive impairment reduces the reliability of these measures 3
• There is a lack of sufficient training and education for healthcare professionals in managing pain in dementia, and evidence-based guidance is urgently needed 4
• The assessment of pain in dementia is challenging due to the limited capacity of self-report by these individuals, and observational methods are relied upon 4

Potential Therapeutic Interventions

• Targeting noradrenergic dysfunction and microglial activation may improve patient outcomes for those with chronic pain and Alzheimer's disease 5
• The use of AChE-Is such as neostigmine and rivastigmine may improve cognitive function and manage chronic pain in Alzheimer's disease 1
• The endocannabinoid system may be a potential target for the treatment of chronic pain in Alzheimer's disease 2