Painkiller danger for dementia

Some popular painkillers may exacerbate the symptoms of dementia.

Opioid-based painkillers such as buprenorphine are frequently prescribed for people with dementia in care homes to treat clinically significant pain.

A team from the University of Exeter, UK, King’s College London, UK, and the University of Bergen, Norway, looked at the safety of these drugs.

They recruited 162 people from 47 Norwegian care homes who had advanced dementia and significant pain, and were given either paracetamol or buprenorphine. Those on buprenorphine had more than three times the rate of harmful side-effects.

The buprenorphine group was also significantly less active during the day, and showed a significant rise in side effect such as personality changes, confusion and sedation. These changes can seriously impact people’s lives in dementia, say the team.

They report that, after paracetamol, opioid-based painkillers are often the next line of treatment for clinicians in people with dementia, but current guidance fails to consider that people with dementia require smaller doses than normal and adverse effects are riskier.

Professor Clive Ballard and the team now want to see studies on appropriate dosing of painkillers such as buprenorphine in this population. Their work was presented this week at the Alzheimer’s Association International Conference 2018, held in Chicago, Illinois, USA.

Professor Ballard said: "Pain is a symptom that can cause huge distress and it’s important that we can provide relief to people with dementia. 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.

“We need to establish the best treatment pathway and examine appropriate dosing for people with dementia."

Erdal, A. et al. A Randomized, Placebo-Controlled Trial to Investigate Safety in People with Dementia or Buprenorphine Transdermal System for Pain Management. Presented at the Alzheimer’s Association International Conference 2018, held in Chicago, Illinois, USA, on Tuesday July 24.