 they couldn’t speak and ask for medication), had oven mitts put on their hands (so they couldn’t write), and were tied in a chair.
I think the most significant finding of the Husebo study is that simply prescribing acetaminophen on a fixed schedule can have a significant impact on the lives of many patients.
In prescribing medications for geriatric patients, we are appropriately concerned about the increased risk of adverse events from changes in physiology associated with aging and the increased frequency of comorbid disorders. We worry about prescribing drugs such as opioids that can be associated with major adverse events, even in relatively healthy younger patients. If fixed-schedule acetaminophen alone can have such a major effect in so many patients, there is no reason this approach should not be used far more frequently than it is.
One criticism of the Husebo study: the authors do not mention whether there was a reduction in the use of antipsychotic medications, which they note might be a major benefit of improved pain treatment, or diminished use of non-study analgesics by those in the treatment group as one might expect.
A final note: it would have been interesting if the authors had used a serotonin-norepinephrine reuptake inhibitor instead of pregabalin (Lyrica) in their study. Depression is common among geriatric patients--including those with dementia. We might have had insights as to whether a drug such as duloxetine (Cymbalta), which is FDA approved both as an analgesic and an antidepressant, would have even more of an effect than pregabalin, which provides similar analgesia but has a minimal if any antidepressant effect.
1. Husebo BS, Ballard V, Sandvik R. Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: a cluster randomized clinical trial. BMJ. 2011;343:d4065 doi: 10.1136/bmj.d4065 http://www.bmj.com/content/343/bmj.d4065.full
2. Sengstaken EA, King SA. The problems of pain and its detection among getiatric nursing homes residents. J Am Geriatr Soc. 1993:41:541-544