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Chronic Pain Might Hasten Cognitive Decline in Older Adults

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Authors: Whitlock EL et al., JAMA Intern Med 2017 Jun 5;

Persistent moderate-to-severe pain was associated with about a 2% increase in absolute risk for developing dementia.
One quarter to one third of older adults have chronic pain, and cross-sectional studies have shown associations between chronic pain and cognitive decline. In this study, researchers used data from a national health and retirement study to explore the longitudinal relation between chronic pain and subsequent cognitive decline in about 10,000 older adults (median age, 73; mostly white women). Participants were assessed every 2 years for pain and cognitive function, and those who reported moderate-to-severe pain at baseline and at 2 years — about 11% of participants — were considered to have persistent pain; those with less or no pain served as the control group. Baseline prevalence of arthritis and depression was higher in the persistent-pain group than in controls (91% vs. 60%).

At median follow-up of about 10 years, cognitive decline was greater in the persistent-pain group than in controls. In analyses adjusted for a wide range of demographic and clinical factors (but not for medications such as opioids or psychotropic drugs), risk for developing dementia was significantly higher in persistent-pain patients than in controls (about 22% vs. 20%). Risk for having difficulty managing medications or finances was also about 2 percentage points higher in persistent-pain patients.

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This association between persistent pain and cognitive decline might represent yet another good reason for developing more effective ways to control chronic pain in older adults. The authors note plausible explanations for their observations, including attentional impairment and subsequent memory dysfunction. However, an important limitation of this study is the absence of adjustment for patients’ use of medications with central nervous system side effects. Those effects (and not the pain itself) might have contributed to the study’s findings.

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