Etude douleur chronique chez des patients atteints de démence

Publication article sur la douleur chronique chez des patients atteints de démence

L'équipe de Nicolas Kerchove du CHU de Clermont-Ferrand a récemment publié, en collaboration avec le réseau ReDSiam, une étude utilisant un nouvel algorithme pour identifier la douleur chronique chez des patients atteints de démence, celui-ci est disponible sur le site d'Elsevier.

Le code de l'algorithme est disponible dans l'espace co' réservé aux membres de ReDSiam dans l'onglet Autres>Douleurs chroniques sur cette page.

Objectives: Chronic pain (CP) remains one of the most incapacitating pathologies among older people. Alzheimer’s disease and Related Dementia (ADRD) is known to disturb pain perception and reduce the ability to report it. No study has yet assessed the prevalence of all types of CP and defined with at least 3 or 6 months duration, among people with ADRD. This nationwide cross-sectional study aim to estimate the prevalence of CP among people living with an ADRD from 2017 to 2019 using EGB databases.

Participants: People with ADRD (ICD-10 codes: F00, F01, F02, F03, G30, G310, G311 and G319 for DGN_PAL or DGN_REL or ASS_DGN from tables MCO), >40 years old, treated with cognitive stimulants (cholinesterase inhibitors (N06DA from table IR_PHA_R) and memantine (N06DX01 from table IR_PHA_R) or with a diagnosis/long-term illness (table EB_IMB_R) of ADRD and matched with a comparison sample (non-ADRD). To avoid erroneous inclusion of individuals, individuals had to have at least two dates of diagnosis of ADRD, or two dispensations of cognitive stimulants, or to have a diagnosis of ADRD associated with a dispensation of cognitive stimulants whatever the date of diagnosis or prescription between 2005 and 2019.

Measurements: The prescription drug (table IR_PHA_R), the national hospital discharge (tables MCO), and the French pain center databases (table MCO_UM) of the healthcare system database were used to identify patients with CP. People treated with analgesic drugs (ATC codes: N02, M01, M02A, N03AX12, N03AX16, N06AA04, N06AA09, N06AA10, N06AX16, N06AX21, N01BB02, and N01BB52) for ≥6 months consecutively or with a medical diagnosis (R521, R522 and M797) of CP or referred to a pain center were considered as having CP. We have restricted our selection to these codes because they are the only reliable ones to confirm the presence of chronic pain. Other codes that could indicate acute pain, such as M00 to M99 (musculoskeletal pain) or R529 (unspecified pain), were not selected. The presence of CP was confirmed only in case of continuous and ongoing treatment during the inclusion period (2017-2019), for at least 6 consecutive months with an interval of less than 35 days between two consecutive prescriptions. The interval of 35 days is based on the fact that in France, prescribed drugs are delivered for a maximum duration of 4 weeks, to which a grace period of 7 days is added to avoid wrongly concluding that there is a break in continuity of treatment. This methodology prevented us from including patients with probably non-chronic pain.

Results: 48,288 individuals were included. The estimated prevalence of CP in people with an ADRD was from 57.7%[52.9;63.3] to 57.9%[53.0;63.9], and slightly higher than the comparison sample (from 49.9%[47.0;53.2] to 50.4%[47.3;53.9], p<0.001). About 25% of people with ADRD treated for CP before the diagnosis of their ADRD are no longer treated for their CP.

Conclusions: The high prevalence of CP among people living with ADRD should alert practitioners' attention to the need for effective pain assessment and management in this population who has difficulties to express and feel pain.

Bravo à eux et bonne lecture !

Le Bureau ReDSiam