• Bettina S Husebo, Clive Ballard, Jiska Cohen-Mansfield, Reinhard Seifert, and Dag Aarsland.
• Department of Public Health and Primary Health Care Center for Elderly- and Nursing Home Medicine, University of Bergen, Bergen, Norway; Center for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway. Electronic address: Bettina.Husebo@isf.uib.no.
• Am J Geriatr Psychiatry. 2014 Jul 1;22(7):708-17.

ObjectivesBehavioral disturbances and pain are common in nursing home (NH) patients with dementia. An association between pain and increased agitation has been suggested, and recently a significant reduction of agitation has been demonstrated by pain treatment in patients with moderate to severe dementia. We now examined which specific agitated behaviors respond to individualized pain treatment.DesignCluster randomized clinical trial.Setting60 clusters (i.e., clusters defined as single independent NH units) in 18 NHs within five municipalities of Western Norway.Participants352 patients with moderate to severe dementia and clinically significant behavioral disturbances.InterventionThe control group received usual treatment and care. According to a predefined scheme for 8 weeks, all patients in the intervention group received individual daily pain treatment with acetaminophen, extended release morphine, buprenorphine transdermal patch, and/or pregabaline.MeasurementsCohen-Mansfield Agitation Inventory subscales and items.ResultsAnalyses demonstrated that Factor 3 (Verbally agitated behaviors) showed the largest significant difference (DF = 1204.0, t = -4.308, p <0.001), followed by Factor 2 (Physically non-aggressive behaviors) (DF = 1198.0, t = -2.672, p = 0.008), and Factor 1 (Aggressive behaviors) (DF = 1196.0, t = -2.093, p = 0.037) after 8 weeks, by a linear random intercept mixed model in two-way repeated-measures configuration with adjustment for heteroscedasticity.ConclusionWe found that verbal agitation behaviors such as complaining, negativism, repetitious sentences and questions, constant request for attention, and cursing or verbal aggression responded to pain treatment. In addition, restlessness and pacing were sensible to analgesics. Such behaviors should therefore lead to an assessment of pain, and pain treatment. Further studies comparing how pain treatment should be balanced against other strategies including psychotropic drugs are needed.Copyright © 2014 American Association for Geriatric Psychiatry. All rights reserved.

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