Researchers from the University of Cordoba’s Nursing Department have discovered that the presence and levels of two pain biomarkers in saliva could be used as an effective and non-invasive method to diagnose pain in people with dementia and communication difficulties. Pain is often underdiagnosed and undertreated in dementia patients, particularly those in advanced stages who are unable to communicate effectively.
Pain and dementia are both more prevalent in older adults, and finding alternative and complementary methods to diagnose pain in individuals with impaired verbal communication has been a goal for researchers and healthcare professionals. The Nursing Department at the University of Cordoba has been studying pain in neurodegenerative diseases, including Alzheimer’s disease, for years. In collaboration with the University of Jaén, the department has recently published a study showcasing how saliva can be utilized as a reliable and non-invasive pain detection tool in dementia patients.
The researchers examined the levels of sTNFR2 (Soluble Tumor Necrosis Factor Receptor 2) and SIgA (immunoglobulin A) pain biomarkers in saliva samples taken from patients over the age of 65 who had been diagnosed with moderate to advanced stage dementia and had an inability to communicate. These samples were compared to a control group of individuals over the age of 65 without dementia.
This new tool could complement observational pain scales and allow healthcare professionals and caregivers to assess the patient’s condition in a simple and non-invasive manner. If necessary, appropriate analgesia can then be employed, thereby improving the patients’ overall quality of life.
The researchers have found that sTNFR2 and SIgA, which are related to pain through inflammation, can be detected in saliva. This is particularly significant as most patients from whom samples were obtained were in advanced stages of dementia and had limited mobility, making it important to minimize any irritation or invasiveness when obtaining samples.
Previous studies had examined pain biomarkers in blood or plasma, making this the first determination of pain biomarkers in saliva. The results showed lower levels of sTNFR2 in dementia patients compared to the control group, suggesting the modulation of inflammation. On the other hand, an increase in SIgA was observed in people with dementia, signaling an alteration in the immune system’s response. These biomarkers can be used to evaluate the progression of pain throughout the course of the disease, particularly during the moderate to advanced stages.
Traditionally, the PAINAD scale has been used to detect pain in patients with limited communication. This scale is based on five behavioral indicators: breathing, vocalization, facial expression, body language, and consolability. The saliva biomarkers proposed by the researchers can now be corroborated with data obtained through the scale, confirming their effectiveness.
The researchers emphasized the importance of this method in improving the quality of life for patients with an incurable disease. To further validate their findings, testing with a larger sample size in a specific environment, such as a nursing home, could be the next step in implementing the use of this tool.