treating arthritis pain in patients with Lewy Body dementia

[adrienurse, LPN]

As you may know, people with the Lewy Body form of dementia are extremely sensitive to neuroleptics. I've seen even the smallest doses cause delerium and CNS depression. This makes pain contol very challenging. As you also may know that pain is also a key cause in agitation for people who cannot express their needs.

So that leads to the problem of pain control in people who have this condition where use of NSAIDS (even at their maximum doses) are not adequate for pain control. Does anybody have any clever solutions for this? With quality of life in mind of course.

[florry]

The problem is that you have to find remedies that is not affecting CNS, and often use local treatment:

An onitment from Germany: ARNIKA SALBE, is good for problems as arthritis. In Germany and Norway it is not by presciption, but only sold in pharmacy.

I Suppose you know about IBUMETIN GEL AND ORUDIS GEL, both gel to use loccally, and be carefull ith NSAID oral taken (too high dose and bleeding complication).

We have had some pt. who has responded good by massage, thouch therapy, foot-care: warm water, and massage to the feet.

If your workplace has volontairs; they can learn simple tricks from the physioterapist and get supervision from you (maybe pt us marevan, has H blood pressure, diabetes and something like that.)

I hope this was some advice

from Florry :)

[florry]

I thougt about something that helps RA pt. but I know its really difficult with pt. wiht dementia. But a local cortison injection giiven by a professionel MD is not hurting if its done in the ringt way.

I know korticon is contraindic. in pt with psych. either organic or non-organid head-disorder, but I kow that we in our ward used a low dose cortison to some of the pt. with severe dementia, and their wellbeing was remarkable better, so also the behavior. Maybe one have to do a choise: what is worst....Discuss it with the MD. I know in worst case, the pt. can get psychotic, but local treatment is better.....Just something to discuss, maybe try, even its very touchy because this pt. are as "china porselain" in their head/cns-metabolic.

From Florry

(My heart is belonging to pt. with dementia. I have never learned so much as from them about life, suffering, joy, family and care through my 7 years together with them and their families) :nurse: