Cognitive Function Impairment in Patients with Neuropathic Pain Under Standard Conditions of Care

Abstract

The objective of this study is to analyze the prevalence to cognitive function impairment (CI) in a pragmatic cohort of subjects with different types of neuropathic pain under standard conditions of care by means of a cross-sectional baseline analysis of a sample of patients with NeP enrolled in a pragmatic, prospective, multicenter study evaluating the effectiveness of gabapentin. A total of 1519 patients (58.8% women), aged > or =18 years (mean [SD]=56.0 [13.7]), with neuropathic or mixed neuropathic and nociceptive pain for a mean (SD) of 1.1 (2.8) years were enrolled in the study. Pain was assessed with the short form of the McGill Pain Questionnaire, and cognitive function was measured with the Mini-Mental State Examination (MMSE). A score < or =24 on the MMSE was considered as CI. Multivariate logistic regression models were used to estimate CI prevalence. CI prevalence was substantially higher in patients with NeP than that reported in the general Spanish population, and significantly higher than in patients with mixed neuropathic and nociceptive pain: 11.4% (8.5%-14.3%) vs. 6.4% (4.6%-8.7%), P=0.006 (adjusted odds ratio=1.88 [1.21-2.91]). Prevalence significantly increased with age, up to 32.2% (20.6%-45.6%) in those with NeP, and to 28.2% (15.0%-44.9%) in those with mixed syndromes, for the age group > or =75 years, P<0.001 within age groups. Symptoms of anxiety and obesity, and to a lesser extent, symptoms of depression, were also factors associated with a higher prevalence rate of CI. This analysis showed that, after adjusting for confounding factors, the prevalence of CI was substantially higher in patients with NeP than those with mixed pain and the reference general population. Age, anxiety, depression, and obesity were factors found to be significantly associated with CI.

Validation of an air-puff passive-avoidance paradigm for assessment of aversive learning and memory in rat models of chronic pain

“…There is a substantial body of evidence suggesting that chronic pain is associated with cognitive impairment in human patients (Eccleston and Crombez, 1999;Hart et al, 2000;Moriarty et al, 2011;Povedano et al, 2007). As such, valid disease models of chronic pain should mirror this clinical phenomenon.…”

“…Clinical studies have shown that chronic pain is associated with impairments in cognitive parameters such as learning, memory and decision-making tasks (Apkarian, 2008;Apkarian et al, 2004;Dick et al, 2002;Dick and Rashiq, 2007;Dufton, 1989;Eccleston, 1994;Hart et al, 2000;Kewman et al, 1991;McCracken and Iverson, 2001;Oosterman et al, 2010;Povedano et al, 2007), but few studies have investigated the effect of pain on aversive learning or recall of aversive memory. However, reporting of previous pain is known to be distorted in chronic pain patients (Bryant, 1993;Eich et al, 1985).…”

Sensory function after cavernous haemangioma: a case report of thermal hypersensitivity at and below an incomplete spinal cord injury

“…No cognitive impairment was detected with the Spanish version of the MiniMental State Examination (Mini-Examen Cognoscitivo, 33/35), 16 which has previously been identified in NP patients. 17 As such, thermal psychophysical sensory rating and pain questionnaire data generated by this individual were unlikely to be unduly affected by cognitive impairment. However, measurement of anxiety as a NP comorbidity, performed with the Spanish version of the State-Trait Anxiety Inventory 18 (as recommended by the IMMPACT group), 19 detected a moderate level for this case report (State: 50, Trait: 21).…”

Chronic pain-associated cognitive impairment

“…Поэтому особый интерес представляют результаты исследований когнитив-ных особенностей у пациентов с ХБ моложе 50 лет в сравне-нии с пациентами с ХБ более старшего возраста. Анализ ис-следований, проведенных с 1990 по 2015 г., показал, что от-рицательного влияния ХБ на когнитивные функции у более молодых пациентов не обнаруживается, либо оно весьма незначительно, а когнитивные показатели у молодых паци-ентов с ХБ не отличаются по этим показателям от таковых у здоровых лиц [2,3,6,21]. М. Povedano и соавт.…”

“…М. Povedano и соавт. [21] показа-ли, что результаты тестирования по краткой шкале оценки психического статуса (Mini-Mental State Examination, ММSE) <24 баллов (что соответствует деменции) практиче-ски отсутствуют у молодых пациентов с ХБ, но процент па-циентов с таким суммарным баллом устойчиво возрастает с возрастом. Авторы объясняют полученные данные влияни-ем ХБ на когнитивные функции после преодоления опреде-ленного возрастного порога.…”