Tylenol Increases Activity for Nursing Home Residents with Dementia

One of the great frustrations in treating elderly patients with dementia is their inability to communicate their pain, but a study by St. Louis University researchers suggests that pre-emptive pain relief should be part of the treatment plan.

John T. Chibnall, Ph.D., professor of psychiatry at Saint Louis University School of Medicine and lead author of the study, said nursing homes should consider the potential benefits of routinely giving over-the-counter painkillers to residents who have dementia and are likely to have from chronic pain.

"The assumption is that people with dementia don't feel pain because they're demented," said Chibnall. "Actually, they do feel it; they just can't tell you about it."

During the study nursing home residents with moderate to severe dementia were given acetaminophen. These residents were more socially active than those who received a placebo.

Acetaminophen (Tylenol) was given because it has few side effects, is routinely given for pain control in nursing homes, and is not habit forming or sedating, Chibnall said.

Those who received the acetaminophen were more active than the others. They spent less time alone in their rooms and more time interacting with others, watching television, listening to music, engaging in work-like activities and talking to themselves.

"Treating their pain seems to energize them somewhat, which was manifested in more positive engagement with their environment," Chibnall said. "Standard pain assessment requires levels of communication and language comprehension that people with advanced dementia, by definition, do not have."

Chibnall said that patients who have a history of conditions where pain is a primary symptom - including arthritis, fractures, diabetic neuropathy, chronic low back pain or headaches - are the most likely to benefit from routine analgesics, such as Tylenol.

"The current findings are particularly noteworthy because they were obtained with acetaminophen, a mild analgesic that does not carry the side-effect risks of more potent opioid analgesics. Under certain circumstances, prophylactic treatment of pain in elderly persons with dementia therefore appears safe and effective in increasing active engagement with the environment."