Nonpharmacological Interventions for Pain Management in Patients With Dementia

Old woman with dementia and therapist while painting in creative painting class
This review systematically synthesized current evidence on nonpharmacological interventions to manage pain in people living with dementia.

Several nonpharmacological interventions are available for reducing pain in patients with dementia, but more high-quality research has yet to be completed, researchers reported in a literature review published in the International Journal of Nursing Studies.

PubMED, CINAHL, Scopus, and Web of Science Databases were searched for original research published in English in 1990 or later that analyzed nonpharmacological interventions for pain in patients with dementia. A total of 7 randomized controlled trials, 3 quasi-experimental studies, and 1 cohort study met inclusion criteria.

Sample size (total 486) ranged from 9 to 111 participants in the studies, which were conducted in Australia, Hong Kong, South Korea, France, Spain, and the United States.

Individuals tended to be female (62% to 90% in the 10 studies that reported gender) and white (86% to 100%), in the 3 studies that reported race.  There were 7 studies that exclusively included participants with ongoing pain, while 4 enrolled patients with and without pain.

The studies each had high risk of bias in at least 1 domain, the researchers reported. A total of 4 of the randomized controlled trials had low risk in random sequence generation and allocation concealment while 2 randomized controlled trials had double-blind design. There were 5 studies that had a high risk of incomplete outcome data while 3 had high risk in selective reporting. Risk of bias was rated as high for studies that tested interventions that may not be able to function with fully blind participants or researchers.

A total of 3 of the randomized controlled trials had significant differences in gender, cognitive status, age, or behaviors at baseline, while 2 had no baseline differences between groups and 2 did not analyze differences between groups.

There were 7 studies that used pain assessment tools with relatively good reliability and validity, while the rest used tools with relatively low reliability and validity, the review authors reported. There were 8 studies that used pain assessment tools designed for use with people living with dementia.

Reflexology, music therapy, ear acupressure, person-centered environment program, cognitive behavioral therapy, personal assistive robot, singing and painting, the tailored pain intervention, and play activity studies reported statistically significant improvement. Each was tested in 1 study, total.

The researchers said factors to consider in selecting an intervention include an individual’s current cognitive ability to adhere to treatment and individuals’ preferences, which may prompt improved responses.

Cognitive behavioral therapy, painting combined with singing, person-centered music therapy, and play activity may not work as well for people with more advanced dementia due to the level of active participation required, while reflexology, ear acupressure, tailored pain intervention, personal assistive robot, and person-centered environment program could be helpful across stages of dementia, according to the investigators.

“Clinicians should consider working collaboratively with older adults and their families to understand each individual’s needs and preferences,” the researchers said. “This will again serve to promote better adherence and treatment outcomes. Finally, individuals’ responses to an intervention should be periodically evaluated and alternative interventions may be considered when the effect is not satisfactory.”


Liao YJ, Parajuli J, Jao YL, Kitko L, Berish D. Nonpharmacological interventions for pain in people with dementia: A systematic review. Int J Nursing Studies. 2021;124 (December): 104082. doi: 10.1016/j.ijnurstu.2021.104082