Study Explores Relationship Between Pain and Cognitive Impairment

A recent study exploring the association between pain and cognitive impairment (CI) found that pain and CI each increase the severity of the other; that is, when pain progresses from acute pain to high impact chronic pain (HICP), the severity of CI increases, and as the severity of CI increases, the severity of pain increases. Further, the study found that people with comorbid chronic pain and CI are in a much higher state of self-reported disability than people with either alone. The study, published in a recent issue of The Clinical Journal of Pain, was supported by the National Center for Complementary and Integrative Health (NCCIH), a component of the National Institutes of Health (NIH).

The researchers analyzed data from the 2017 National Health Interview Survey (NHIS) Family Core, Family Disability Core, and Sample Adult Core. These interviews were conducted in 36,617 households and 33,157 families, with 26,742 adults aged 18 years and older completing the Sample Adult questionnaire. Based on National Center for Health Statistics sampling weights, the participants represented 246.7 million adults in the U.S. population.

Chronic pain was defined as pain on most days or every day in the past 6 months, according to the U.S. National Pain Strategy and National Institutes of Health Task Force on Chronic Back Pain. High impact chronic pain (HICP) was defined as chronic pain that limited life or work activities on most days or every day during the past 6 months.

Among the study’s findings were:

• As pain increased from “no pain” to HICP, the prevalence of CI increased from 2.99 percent to 18.19 percent. Similarly, as the level of CI increased from no impairment to substantial CI, the prevalence of pain increased from 62.44 percent to 83.20 percent.
• While only 4.15 percent of individuals without either pain or CI reported having poor or fair health, this increased to 81.8 percent in individuals reporting substantial CI or dementia and HICP.
• Approximately 20 percent of individuals with substantial CI or dementia but no pain reported receiving health care 10 or more times in the previous year; this increases to 30 percent in those with acute pain and to 50.23 percent in those with HICP.
• Interactions between pain and CI were associated with poorer health status, higher health care use, and more disability than that seen in individuals with only pain or only CI.
• Individuals with HICP and either less than substantial CI or substantial CI were more likely to be dissatisfied with their health care than those with either HICP or CI alone. However, individuals with no pain but with some CI had similar levels of dissatisfaction with health care as those without pain or CI. These data suggest that pain has a stronger association with an individual’s dissatisfaction with care than CI.

The researchers suggested that these results may encourage health care providers and family members caring for cognitively impaired patients to regularly assess and manage such patients for pain. They noted that best practice guidelines are generally silent on multidisciplinary, integrated care for these comorbid conditions, increasing the potential for inadequate care. In addition, the researchers noted that pain medications might be causing some of the CI.  Finally, it was suggested that patients with CI should be monitored closely to ensure individuals are not underestimating or overestimating their pain due to memory loss.