We know that as much as 50 percent of dementia patients experience regular pain. But does providing a common painkiller help or hurt patients? A painkiller usually prescribed for dementia patients could actually triple the chance of experiencing harmful side effects and changes to personality, new research shows.
The painkiller in question is called buprenorphine, an opioid available under a number of names: Buprenex, Suboxone, Subutex, Belbuca and Sublocade. It’s also sold in patch form under the name Butrans. It’s often used to treat opioid dependency, but also prescribed in dementia patients, because it’s easy to administer to people who have trouble swallowing.
But a new study highlights the dangers of drugs like buprenorphine in dementia patients. In Norway, where the study was conducted, about 10 to 15 percent of dementia patients are prescribed a buprenorphine patch. In this study, forty-four patients with advanced dementia in nursing homes were randomly assigned a patch that delivered the medication, while another 45 received a placebo. Researchers observed the patients, whose caregivers did not know which patch they received, for 13 weeks.
Those who got the buprenorphine patch had an immediate drop in activity, starting on the second day of the trial and measured by an activity tracker. They were also 24 more times likely to drop out entirely; twenty-three patients with the real patch dropped out of the trial, compared with six that got the placebo. Researchers saw personality changes, confusion and sedation in those who were prescribed buprenorphine.
Pain management in dementia patients is a difficult area to navigate, according to experts.
“From calls to our helpline we know managing pain is vitally important, but sadly it often goes unmanaged as people in the later stages of dementia may find it more difficult to express the pain they are in,” said Sally Copley, Director of Policy Campaigns and Partnerships at Alzheimer’s Society.
Copley said that the study indicates “very careful consideration” should be taken when prescribing opioids to dementia patients.
Opioids are a common line of defense against pain in dementia patients—about 40 percent of people with dementia in nursing homes are prescribed one. But what this study points out, said authors, is that pain management for dementia is not a one-size-fits-all approach.
The research, conducted by scientists from the University of Exeter and University of Bergen, showed that people with dementia are more sensitive to opioid-based painkillers than people without Alzheimer’s. In a related study on mice conducted by the same team, those with Alzheimer’s needed a lower dose to manage pain, and experienced adverse effects when the dosage was increased to what is considered a normal amount.
“Pain is a symptom that can cause huge distress and it’s important that we can provide relief to people with dementia,” said Clive Ballard, of the University of Exeter Medical School and an author of the study. Sadly, at the moment we’re harming people when we’re trying to ease their pain. We urgently need more research in this area, and we must get this dosing right.”
Earlier studies suggest that around 20 percent of dementia patients are overmedicated. The drugs that are most commonly overprescribed or incorrectly prescribed are sleeping tablets, pain drugs, depression drugs and acid reflux drugs—all drugs that typically raise feelings of drowsiness, which has been shown to increase the risk of falls. A report from the Human Rights Watch called the overuse of medication for dementia patients the equivalent of “chemical restraints.”
This research was presented at the 2018 Alzheimer’s Association conference and has not yet been peer-reviewed.