Altered pain processing in people with cognitive impairment
People with cognitive impairment – including dementia – have altered responses to pain, says a review of the literature in Pain. And many of the conditions are associated with increased pain sensitivity.
“Individuals with cognitive impairment can have difficulty communicating the features of their pain to others, which in turn presents a significant challenge for effective diagnosis and treatment of their pain,” the researchers explain.
Because of those communication issues, it has even been suggested that cognitively impaired people have reduced pain sensitivity.
So a team analysed previous studies on pain responses in cognitively impaired patients. They found that:
• Even normal, healthy ageing may be associated with increased vulnerability to pain, as well as slightly reduced cognitive performance. These changes may set up a “vicious circle,” with pain leading to a decline in cognitive function and vice versa.
• The experience of pain tends to be elevated in people with mild to moderate Alzheimer’s disease. Pain sensitivity in late Alzheimer’s disease is unclear.
• The effects of other types of neurodegenerative impairment on pain processing seem to vary. Pain responses seem to be decreased in people with frontotemporal dementia (Pick’s disease) and Huntington’s disease, but increased in those with Parkinson’s disease. Effects on pain sensitivity may vary even for diseases affecting similar areas of the brain.
• Various developmental disabilities (such as autism, cerebral palsy and intellectual disability) are associated with increased pain sensitivity.
• Pain processing seems to be affected in people with brain damage, such as stroke and traumatic brain injury.
The study therefore suggests that pain processing is often altered in people with cognitively impairment, often with increased sensitivity to painful stimuli.
“It appears that those with widespread brain atrophy or neural degeneration… all show increased pain responses and/or greater pain sensitivity,” highlights Dr Ruth Defrin.
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Image credit: Petras Gagilas
