Nonpharmacological Pain Management for People With Dementia: A Scoping Review Mapping Research Gaps From a Pragmatic Lens

Abstract

Background: Nonpharmacological pain interventions are effective but underutilized in people living with dementia (PLWD). Leveraging an implementation lens (i.e., the Readiness Assessment for Pragmatic Trials [RAPT] model) to scope the literature may reveal research gaps contributing to this underutilization. The purpose of this scoping review is to summarize the literature, map the studies to the RAPT model, and identify research gaps.

Methods: Following Arksey and O'Malley's framework and Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA- ScR) guidelines, two reviewers screened, collated, extracted, and mapped data from eligible studies to the 9 RAPT domains (implementation, evidence, risk, feasibility, measurement, cost, acceptability, alignment, and impact). We used descriptive statistics to summarize the studies and the extent to which interventions were mapped to RAPT domains.

Results: Of 81 studies covering 24 interventions, 64% were in long-term care facilities (LTCFs), 66% reported unspecified pain, and 32% reported unspecified dementia. Of the interventions, the Tailored Activities Program had literature informing the most domains (6 domains), followed by exercise, pain education, and stepwise approaches (5 domains each). Most studies were mapped to the evidence domain (33 studies), few studies to feasibility (7 studies), acceptability (5 studies), and implementation (10 studies) domains, one study to cost, and no studies to risk or impact.

Conclusion: Despite the variety of nonpharmacological pain interventions studied, there is a notable lack of literature that aligns with the RAPT model. Furthermore, there is limited consideration of the specific pain and dementia conditions, as well as the diverse environments where PLWD reside and receive care. These gaps underscore the need for robust and holistic research to ensure pain interventions are effectively tailored and implemented for PLWD. Starting with acceptability and feasibility studies can establish a foundation for building robust evidence, ensuring practical and well-received interventions before larger-scale clinical trials.

Keywords: dementia; nonpharmacological intervention; pain; pragmatic; quality of life; scoping review.