Common painkillers triple harmful side effects in dementia

July 24, 2018, University of Exeter

Researchers from the University of Exeter, King's College London and the University of Bergen are presenting two studies at the Alzheimer's Association International Conference 2018 (AAIC) highlighting a significant increase in harmful side effects related to the use of commonly prescribed opioid painkillers in people with dementia, compared to those on a placebo. Researchers also identified a mechanism that may be causing the problem.

In a of 162 Norwegian care home residents, the team found a significant rise in side effect such as personality changes, confusion and sedation, which can seriously impact people's lives in . The team is now calling for studies to examine appropriate dosing of painkillers such as buprenorphine for people with dementia.

Around half of people with dementia who are living in care homes experience clinically significant pain. Previous research has recognised that pain is often under-diagnosed and poorly managed in people with dementia, impacting on quality of life.

After paracetamol, opioid-based painkillers are often the next line of treatment for clinicians in people with dementia, and are prescribed to up to 40% of people with dementia living in care homes. They ease pain effectively, yet current prescribing guidance does not take into account the fact that people with dementia get effective pain relief from smaller doses than are commonly prescribed, and are particularly sensitive to .

The trial team, led by the University of Bergen, studied 162 people from 47 Norwegian who had advanced dementia and significant depression. In those who were assigned buprenorphine as part of their treatment pathway, harmful side-effects more than tripled. The researchers also found that those taking buprenorphine were significantly less active during the day.

Clive Ballard, Professor of Age-Related Diseases at the University of Exeter Medical School, 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."

Importantly, research led by Professor Ballard's team and also presented at the conference gives insight into the mechanism of why people with dementia are more susceptible to opioid-based painkillers, suggesting they over-produce the body's natural opioids.

The study treating arthritis in Alzheimer's mice found increased sensitivity to the opioid-based morphine in mice with Alzheimer's disease compared to those without. Those with Alzheimer's disease responded to a much lower dose to ease pain, and experienced more adverse effects when the dose was increased to a normal level. Looking into this further the study found that the Alzheimer's mice produced more of the body's natural endogenous opioids such as endorphins. The study, presented as a poster at AAIC, also concludes that dosing of opioid-based painkillers urgently needs to be reviewed in people with dementia to enable safe and effective treatment of pain, and prevent unnecessary harm and deaths.

Explore further: Opioid analgesics reduce use of antipsychotics in persons with Alzheimer's disease

Related Stories

Opioid analgesics reduce use of antipsychotics in persons with Alzheimer's disease

March 26, 2018
Initiating an opioid analgesic reduced the use of antipsychotics and benzodiazepines in persons with Alzheimer's disease, a recent study from the University of Eastern Finland shows. These drugs are frequently prescribed ...

Long-term opioid use does not increase risk of Alzheimer 's disease

October 24, 2017
Opioid use is not associated with an increased risk of Alzheimer's disease, shows a recent study from the University of Eastern Finland. Researchers did not find any risk neither for long-term use nor for higher cumulative ...

Long-term use of opioid patches common among persons with Alzheimer's disease

November 14, 2016
Approximately seven per cent of persons with Alzheimer's disease use strong pain medicines, opioids, for non-cancer pain for a period longer than six months, according to a recent study conducted at the University of Eastern ...

Avoiding the risk of opioids

June 1, 2018
Dear Mayo Clinic: If opioids are such a problem in our country, why are they used so often to treat pain? Aren't there other effective options for controlling pain that aren't as risky?

Pimavanserin: Relief from psychosis in dementia, without devastating side-effects

February 13, 2018
A new kind of antipsychotic has been found to relieve terrifying and disturbing symptoms suffered by millions of people with Alzheimer's disease worldwide.

Arthritis drugs linked to lower Alzheimer's risk

February 13, 2018
Scientists from the University of Southampton have teamed up with researchers from the University of Oxford to look at whether existing drugs for arthritis have any effect on a person's risk of developing dementia. By looking ...

Recommended for you

Hypothesis underpinning dementia research 'flawed'

October 16, 2018
A hypothesis which has been the standard way of explaining how the body develops Alzheimer's Disease for almost 30 years is flawed, according to a University of Manchester biologist.

Study suggests biological basis for depression, anxiety, sleep disturbances in older adults

October 15, 2018
UC San Francisco researchers, in collaboration with the unique Brazilian Biobank for Aging Studies (BBAS) at the University of São Paulo, have shown that the earliest stages of the brain degeneration associated with Alzheimer's ...

Many cases of dementia may arise from non-inherited DNA 'spelling mistakes'

October 15, 2018
Only a small proportion of cases of dementia are thought to be inherited—the cause of the vast majority is unknown. Now, in a study published today in the journal Nature Communications, a team of scientists led by researchers ...

Scientists create new map of brain region linked to Alzheimer's disease

October 8, 2018
Curing some of the most vexing diseases first requires navigating the world's most complex structure—the human brain. So, USC scientists have created the most detailed atlas yet of the brain's memory bank.

Previously unknown genetic aberrations found to be associated with Alzheimer's progression

October 8, 2018
In a large-scale analysis of RNA from postmortem human brain tissue, researchers at the Icahn School of Medicine at Mount Sinai and Columbia University have identified specific RNA splicing events associated with Alzheimer's ...

Periodontal disease bacteria may kick-start Alzheimer's

October 4, 2018
Long-term exposure to periodontal disease bacteria causes inflammation and degeneration of brain neurons in mice that is similar to the effects of Alzheimer's disease in humans, according to a new study from researchers at ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.