Postoperative Pain Management in Alzheimer’s Disease—a Review

Purpose of Review Individuals with dementia and Alzheimer’s disease (AD) often receive inadequate analgesia compared to those without cognitive impairments [24-26]. However, undertreated pain contributes more to cognitive decline than analgesics. A comprehensive evaluation of available therapies considering administration modes, dosages, potential interactions, and side effects is necessary. Our review provides an extensive report on current methods of pain assessment, strategies for dealing with postoperative pain, and the challenges anesthesiologists face, and points out the inadequacy of current literature to formulate a comprehensive strategy. Recent Findings Trials have shown that for demented patients, there is a significant decrease in the dose of analgesia. Moreover, the ineffective assessment of the degree of pain leads to under-treatment. Studies are being conducted to assess validity of pain scales, current limitations, and suggestions to enhance their sensitivity. Individualizing the opioid dose is vital for effective pain management in older adults. Multimodal analgesia can enhance pain relief and reduce opioid consumption and related adverse events. Acetaminophen is a safe non-opioid option, while NSAIDs and centrally acting anticholinergics should be avoided due to potential toxicity. Among opioids, fentanyl, morphine, and oxycodone are considered safe, while pethidine and tramadol should be avoided due to their association with postoperative delirium. Summary Effective postoperative pain management in dementia patients requires individualized approaches, considering specific needs and risks associated with different drugs and administration methods. Certain medications may interact with analgesics and cause serious side effects in demented patients. Further research is necessary to establish guidelines for managing postoperative pain in Alzheimer’s disease.