Authors: Jiang, Xue et al.
Anesthesiology, August 25, 2025. DOI: 10.1097/ALN.0000000000005731
This longitudinal population-based study examined the association between chronic widespread pain (CWP) and cognitive decline, including dementia, using data from the UK Biobank. Although chronic pain has been linked to impaired cognition, the causal mechanisms and structural brain correlates remain uncertain. The study aimed to clarify these relationships and explore potential mediating roles of neuroanatomical and inflammatory changes.
Data were analyzed from 188,594 adults aged 37 to 73 years, followed for 13 years. CWP was defined as self-reported pain affecting the entire body for at least three months. Cognitive performance was evaluated through eight standardized tests encompassing memory, processing speed, executive function, and reasoning. Dementia and mild cognitive impairment (MCI) were identified through hospital records, and brain MRI scans and inflammatory markers were used to explore mediating pathways.
Participants with CWP exhibited significantly higher risks of both MCI (hazard ratio 2.55, 95% CI 1.31–4.97) and dementia (1.53, 95% CI 1.13–2.0) compared to those without CWP. Structural brain changes in regions such as the thalamus, insular and prefrontal cortices, amygdala, and sensorimotor areas were observed among individuals with CWP, along with elevations in systemic inflammatory markers, including lymphocytes, neutrophils, and platelets. Mediation analyses suggested that these neuroanatomic and inflammatory alterations partially explain the link between chronic pain and cognitive decline.
Although causality was not definitively established, the findings indicate that chronic widespread pain is associated with accelerated cognitive deterioration and increased dementia risk, potentially through inflammation-driven and brain-structure–related pathways.
What You Should Know:
Chronic widespread pain appears to increase the likelihood of cognitive impairment and dementia, with structural brain changes and systemic inflammation as potential mediators. These results underscore the importance of early recognition and management of chronic pain not only for physical well-being but also for preserving long-term cognitive health.
Thank you to Anesthesiology for publishing this valuable contribution highlighting the neurocognitive consequences of chronic pain and its possible biological underpinnings.