Pain and delirium: mechanisms, assessment, and management

Elizabeth L Sampson,Thomas Fischer,Emily West

doi:10.1007/s41999-019-00281-2

Abstract

Key summary pointsAimTo provide a clinical overview of the association between pain and delirium, the mechanisms which may underlie this and how pain can be detected and managed in delirium.FindingsThere are few studies in this field. It is likely that pain is a key cause of delirium but this relationship is complex and mediated by many factors. Observational tools may help diagnose pain in delirium but need further testing.MessagePain is a potentially treatable cause of delirium and future research in how to better detect and managed this is required.

Highlights

Both pain and delirium are common problems for older people across a range of clinical and residential settings
Pain affects 20–46% of older people living in the community, and 28–73% of those living in residential care
The prevalence of delirium in the community is low, but a delirium prevalence of 36.8% has been reported in residential aged care settings [2] and the onset of delirium often precipitates presentation to

Summary

Introduction

Both pain and delirium are common problems for older people across a range of clinical and residential settings. In post-operative older populations, Vaurio et al [9] found that oral narcotic analgesics reduced delirium risk when compared to IV and epidural analgesics They suggest that this may be due to oral opioid analgesics resulting in lower blood drug levels. A systematic review of the association between opioids and delirium in older populations found moderate quality evidence suggesting that where acute severe pain occurs (e.g., hip fracture) lower doses of opioids may paradoxically be associated with a higher risk of delirium. Acute or chronic pain may lower the threshold for the development of delirium This is notable in older people with concomitant frailty, acute physical illness or dementia, who have a reduced cognitive reserve.

Key findings

Findings

Compliance with ethical standards