Pain × Delirium

📖 Literature Information and Abstract Translation

Understanding the association between pain and delirium in older hospital inpatients: systematic review and meta-analysis

[Background/Objective] Delirium and pain are common in hospitalized older adults. Their relationship is unclear but clinically important. We aimed to systematically examine the association between pain (at rest, during movement, pain severity) and delirium in such populations.

[Methods] We searched PubMed, EMBASE, CINAHL, PsycINFO, Cochrane, and Web of Science for Medical Subject Heading terms and synonyms ("pain", "analgesics", "delirium") (January 1982 – November 2022). Study eligibility: (1) validated pain measures as exposure, (2) validated delirium tools as outcome, (3) participant eligibility: (1) medical or surgical (elective/emergency) inpatients, (2) length of stay ≥ 48 hours, (3) median cohort age ≥ 65 years. Study quality was assessed using the Newcastle-Ottawa Scale. Odds ratios (OR) for categorical data and standardized mean differences (SMD) for continuous data were collected/calculated, and a multi-level random-intercept meta-regression model was performed. This study was registered as a prospective registration on PROSPERO [18/5/2020] (CRD42020181346).

[Results] 30 studies were selected: 14 reported categorical data and 16 reported continuous data. Delirium prevalence ranged from 2.2% to 55%. Overall, patients experiencing pain were 2.17 times more likely to experience delirium (95% CI 1.35 – 3.06). In multi-level analysis, pain at rest (OR 2.14; 95% CI 1.39-3.30), pain during movement (OR 1.30; 95% CI 0.66-2.56), pain classified as "severe" (OR 3.42; 95% CI 2.09-5.59), and increased pain severity during continuous measurement were associated with an increased risk of delirium. Considerable heterogeneity was observed in both categorical analysis (I2 = 0%-77%) and continuous analysis (I2 = 85%).

[Conclusion] Increased pain was associated with an increased risk of developing delirium. Adequate pain management with appropriate analgesics may reduce the incidence and severity of delirium.

🌱 So What?: What did I find interesting?

Based on previous literature reviews, delirium is a major issue that contributes to hospital-associated functional decline.

Delirium is a condition characterized by an acute, fluctuating decline in functions such as attention, comprehension, and memory.
This occurs suddenly during hospitalization, after onset, or post-operatively.
Honestly, I have been at a loss regarding this.
In other words, I didn't clearly know what to do.

This literature review presented one thing that can be done for delirium.
That is, "pain".
"Please do something about the delirium" is vague, but if it's "Please do something about the pain," it seems like something can be done.
Pain assessment, treatment, and positioning to prevent pain.
And if pain is linked to delirium, it could lead to lowering the risk of delirium.
I want to adopt the mindset of prioritizing thorough pain treatment for delirium.

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