Persistent pain and cognitive decline in older adults: a systematic review and meta-analysis from longitudinal studies

Aguiar, Gabriella Pequeno Costa Gomes de; Saraiva, Marcos Daniel; Khazaal, Eugênia Jatene Bou; Andrade, Daniel Ciampi de; Jacob‐Filho, Wilson; Suemoto, Cláudia Kimie

doi:10.1097/j.pain.0000000000001932

Cited by 22 publications

(31 citation statements)

References 53 publications

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“…Another meta-analysis focused on executive function showed that people with CP might have impaired executive function (Berryman et al, 2014 ). However, a recent meta-analysis showed persistent pain was not associated with the incidence of cognitive decline from prospective longitudinal studies (De Aguiar et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

“…Besides, RBANS is a complex assessment containing many aspects (Weiner et al, 2006 ), and only one part of the two studies was identical. Also, one recent meta-analysis has found this controversial conclusion between persistent pain and cognitive function among the olds (De Aguiar et al, 2020 ). However, they did not care about the different cognitive evaluation methods.…”

Section: Discussionmentioning

confidence: 99%

“…A meta-analysis of longitudinal studies showed that headache was associated with a higher risk of dementia (Wang et al, 2018 ). However, another meta-analysis contained 10 prospective longitudinal studies that showed persistent pain was not associated with the incidence of cognitive decline (De Aguiar et al, 2020 ). A study also demonstrated pain was not associated with incident cognitive impairment in any of the three cognitive domains evaluated (attention, memory, and executive functioning) (Van Der Leeuw et al, 2018a ).…”

Section: Introductionmentioning

confidence: 99%

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Evidence for Cognitive Decline in Chronic Pain: A Systematic Review and Meta-Analysis

et al. 2021

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Background: People with chronic pain (CP) sometimes report impaired cognitive function, including a deficit of attention, memory, executive planning, and information processing. However, the association between CP and cognitive decline was still not clear. Our study aimed to assess the association of CP as a risk factor with cognitive decline among adults.Methods: We included data from clinical studies. Publications were identified using a systematic search strategy from PubMed, Embase, and Cochrane Library databases from inception to October 10, 2020. We used the mean cognitive outcome data and the standard deviations from each group. The standardized mean difference (SMD) or odds ratio (OR), and 95% confidence intervals (CI) were performed for each cognitive decline outcome. I2-values were assessed to quantify the heterogeneities.Results: We included 37 studies with a total of 52,373 patients with CP and 80,434 healthy control participants. Because these studies used different evaluative methods, we analyzed these studies. The results showed CP was associated with cognitive decline when the short-form 36 health survey questionnaire (SF-36) mental component summary (SMD = −1.50, 95% CI = −2.19 to −0.81), the Montreal cognitive assessment (SMD = −1.11, 95% CI = −1.60 to −0.61), performance validity testing (SMD = 3.05, 95% CI = 1.74 to 4.37), or operation span (SMD = −1.83, 95% CI = −2.98 to −0.68) were used. However, we got opposite results when the studies using International Classification of Diseases and Related Health Problems classification (OR = 1.58, 95% CI = 0.97 to 2.56), the Mini-Mental State Examination (SMD = −0.42, 95% CI = −0.94 to 0.10; OR = 1.14, 95% CI = 0.91 to 1.42), and Repeatable Battery for the Assessment of Neuropsychological Status memory component (SMD = −0.06, 95% CI = −0.37 to 0.25).Conclusion: There may be an association between CP and the incidence of cognitive decline when some cognitive, evaluative methods were used, such as short-form 36 health survey questionnaire, Montreal cognitive assessment, performance validity testing, and operation span.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evidence for Cognitive Decline in Chronic Pain: A Systematic Review and Meta-Analysis

et al. 2021

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“…A systematic review by de Aguiar et al [47] concluded that persistent pain was not associated with cognitive impairment in geriatric populations. However, persistent pain was associated with cognitive decline in cases of follow-up length less than 4.5 years.…”

Section: Comparison Of the Results With Other Systematic Reviewsmentioning

confidence: 99%

Comparison of the Impacts of Under-Treated Pain and Opioid Pain Medication on Cognitive Impairment

Jang¹,

Bradshaw²,

Carr³

2022

Cureus

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Purpose: To guide clinicians in balancing the risks and benefits of opioids when treating pain, we conducted two systematic reviews: 1) the impact of pain on cognitive function, and 2) the impact of opioids on cognitive function.Methods: Part one addressed the impact of pain on cognitive impairment; Part two considered the impact of opioids on cognitive impairment. PubMed was used to search for eligible articles. For part one, 1786 articles were identified, of which 23 met our eligibility criteria. For part two, among 584 articles, 18 were found eligible.Results: For part one, 16 studies concluded that patients with chronic pain showed impaired cognitive function; six studies found that chronic pain does not worsen cognitive function; one study concluded that the impact of pain on cognitive function differs based on the underlying cognitive status. For part two, 15 studies found that using opioids to control pain did not cause significant cognitive impairment, while three studies concluded the opposite. Studies evaluating older subjects did not observe different results from those in the whole population for both reviews. Conclusion:The published literature indicates that moderate to severe pain can impair cognitive function, and that careful use of opioid analgesics in such subjects does not necessarily worsen cognition. Although our results are insufficient to support clear guidance due to heterogeneity of cohorts and outcomes, this study may assist primary care providers by rendering explicitly the factors to be considered by providers caring for this population with pain when opioids are considered.

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“…In their meta‐analysis, de Aguiar et al. showed that pain was associated with a higher risk of cognitive impairment only in studies involving short follow‐up 18 . Literature has shown that people with cognitive impairment have increased sensitivity to pain 38–40 .…”

Section: Discussionmentioning

confidence: 99%

Chronic pain and long‐term dementia risk in older adults: Results from a 24‐year longitudinal study

Rouch

Edjolo

Laurent

et al. 2022

Int J Geriat Psychiatry

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Introduction: Chronic pain (CP) was associated with cognitive impairment in previous studies. However, the longitudinal association between CP and dementia remains under debate. We aimed to assess the prospective link between CP and long-term dementia risk in a population-based cohort of older participants, considering covariables linked to CP and cognitive functioning. Methods:The study sample was selected from the PAQUID study, an ongoing cohort of older community-dwellers aged 65 years and over at baseline; Information regarding CP and analgesics consumption was collected using questionnaires. Dementia was clinically assessed every 2 years. The population was divided into 4 groups according to CP and analgesic drugs intake (CP+/A+, CP+/A−, CP−/A+, CP −/A−). An illness-death model was used to estimate the link between CP and incident dementia risk controlled for sex, educational level, comorbidities, depression, antidepressant drugs and analgesics.Results: Five hundred ninety three participants (364 women) who completed a CP questionnaire, were included. They were followed-up over 24 years (mean followup: 11.3 years, SD 7.3). A total of 223 participants (32.5%) had CP, among them 88 (38.6%) took analgesic drugs. Compared to CP−/A− group, CP+/A+ participants had a higher risk of developing dementia in the univariate model (hazard ratio (HR) = 1.73, 95%CI:1.18-2.56; p = 0.0051). However, these results did not persist in the multivariate models (aHR = 1.23, 95%CI:0.88-1.73; p = 0.23). No significant risk for dementia were observed in CP−/A+ and CP+/A− (HR = 1.30, 95%CI:0.84-2.01; p = 0.23 and HR = 1.36, 95%CI:0.95-1.96; p = 0.09, respectively). Conclusion:Our results failed to show a significant relationship between the presence of CP and long-term dementia risk, suggesting that the cognitive decline associated with CP observed in the literature does not appear to be related to Alzheimer's disease or related disorders.

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Persistent pain and cognitive decline in older adults: a systematic review and meta-analysis from longitudinal studies

Cited by 22 publications

References 53 publications

Evidence for Cognitive Decline in Chronic Pain: A Systematic Review and Meta-Analysis

Evidence for Cognitive Decline in Chronic Pain: A Systematic Review and Meta-Analysis

Comparison of the Impacts of Under-Treated Pain and Opioid Pain Medication on Cognitive Impairment

Chronic pain and long‐term dementia risk in older adults: Results from a 24‐year longitudinal study

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