Trial reportEuropean journal of pain (London, England)2014
Impact of a stepwise protocol for treating pain on pain intensity in nursing home patients with dementia: a cluster randomized trial.
Trial report in European journal of pain (London, England), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
32 citing papers in PubMed, 3 syntheses or guidelines pooled it, 83 citations in OpenAlex.
- Exploitation of Autophagy Inducers in the Management of Dementia: A Systematic Review.International journal of molecular sciences · 2024Pooled it
- Algorithm-based pain management for people with dementia in nursing homes.The Cochrane database of systematic reviews · 2022Pooled it
- Identifying and Managing Pain in People with Alzheimer's Disease and Other Types of Dementia: A Systematic Review.CNS drugs · 2016Pooled it
- The effect of paracetamol on care dependency and daily functioning in persons with advanced dementia living in long-term care facilities.BMC geriatrics · 2024Trial
- An intervention to increase physical activity in care home residents: results of a cluster-randomised, controlled feasibility trial (the REACH trial).Age and ageing · 2021Trial
- Quality of life and paracetamol in advanced dementia (Q-PID): protocol of a randomised double-blind placebo-controlled crossover trial.BMC geriatrics · 2018Trial
- Efficacy and Safety of Analgesic Treatment for Depression in People with Advanced Dementia: Randomised, Multicentre, Double-Blind, Placebo-Controlled Trial (DEP.PAIN.DEM).Drugs & aging · 2018Trial
- Teaching Caregivers of Persons with Dementia to Address Pain.The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry · 2017Trial
- The Interactive Relationship between Pain, Psychosis, and Agitation in People with Dementia: Results from a Cluster-Randomised Clinical Trial.Behavioural neurology · 2016Trial
- COSMOS--improving the quality of life in nursing home patients: protocol for an effectiveness-implementation cluster randomized clinical hybrid trial.Implementation science : IS · 2015Trial
- Mechanisms and Characteristics of Chronic Pain in Alzheimer's Disease: A Narrative Review.Current medicinal chemistry · 2026Review
- Pain Cues in People With Dementia: Scoping Review.JMIR mental health · 2025Article
- Pain Management in Cognitively Impaired Older Adults.International journal of nursing and health care research · 2024Article
- Randomization, design and analysis for interdependency in aging research: no person or mouse is an island.Nature aging · 2022Article
- Article
- Pharmacological Pain Treatment in 2012 and 2017 Among Older People with Major Neurocognitive Disorder.Drugs & aging · 2021Article
- Implementation and Evaluation of an Acute Care Multicomponent Intervention for Dementia-Related Behavioral Expressions.Journal of gerontological nursing · 2021Article
- Paracetamol: A Review of Guideline Recommendations.Journal of clinical medicine · 2021Review
- [Pain in dementia].Schmerz (Berlin, Germany) · 2021Review
- Time Trends in Opioid Use by Dementia Severity in Long-Term Care Nursing Home Residents.Journal of the American Medical Directors Association · 2021Article
Corrections and comments
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Authors and funding
7 authors at 5 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPain is frequent and distressing in people with dementia, but no randomized controlled trials have evaluated the effect of analgesic treatment on pain intensity as a key outcome.
methodsThree hundred fifty-two people with dementia and significant agitation from 60 nursing home units were included in this study. These units, representing 18 nursing homes in western Norway, were randomized to a stepwise protocol of treating pain (SPTP) or usual care. The SPTP group received acetaminophen, morphine, buprenorphine transdermal patch and pregabalin for 8 weeks, with a 4-week washout period. Medications were governed by the SPTP and each participant's existing prescriptions. We obtained pain intensity scores from 327 patients (intervention n = 164, control n = 163) at five time points assessed by the primary outcome measure, Mobilization-Observation-Behaviour-Intensity-Dementia-2 (MOBID-2) Pain Scale. The secondary outcome was activities of daily living (ADL). We used a linear intercept mixed model in a two-way repeated measures configuration to assess change over time and between groups.
resultsThe SPTP conferred significant benefit in MOBID-2 scores compared with the control group [average treatment effect (ATE) -1.388; p < 0.001] at week 8, and MOBID-2 scores worsened during the washout period (ATE = -0.701; p = 0.022). Examining different analgesic treatments, benefit was conferred to patients receiving acetaminophen compared with the controls at week 2 (ATE = -0.663; p = 0.010), continuing to increase until week 8 (ATE = -1.297; p < 0.001). Although there were no overall improvements in ADL, an increase was seen in the group receiving acetaminophen (ATE = +1.0; p = 0.022).
conclusionPain medication significantly improved pain in the intervention group, with indications that acetaminophen also improved ADL function.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.