Persistent Pain Linked With Greater Memory Decline & Dementia Probability – Tori Rodriguez, MA, LPC – June 21, 2017
In a population-based cohort study described in JAMA Internal Medicine, older adults with persistent pain showed more rapid memory decline and greater dementia probability compared with adults without persistent pain.
The prevalence of chronic pain in older adults is 25% to 33%, and recovery is less likely in this group compared with younger individuals.
Recent findings demonstrated a link between pain and outcomes that commonly affect the elderly, including functional impairment, cognitive decline, and dementia.
Older adults with chronic pain have been found to have poorer memory and executive function than their younger counterparts, both of which are closely associated with functional independence.
In the current study, data from 10,065 participants (median baseline age, 73; 60% women; 1120 [10.9%] with persistent pain) in the Health and Retirement Study was analyzed to assess the longitudinal effects of persistent pain on memory and the probability of developing dementia.
In addition, the impact of pain-related memory decline on daily functional tasks (ie, medication and financial management) was examined.
Participants initially reported outcomes in 1998 and 2000 and were followed until 2012 or until death or dropout from the study.
Composite memory score and dementia probability were “estimated by combining neuropsychological test results and informant and proxy interviews.”
Patients with moderate to severe persistent pain were compared with age-adjusted peers without persistent pain.
Study participants with persistent pain at baseline had worse depressive symptoms and more functional limitations pertaining to daily tasks vs participants without persistent pain.
These patients also had an increased relative risk of inability to manage medications (11.8%) or finances (15.9%) after 10 years, compared with patients without persistent pain.
In addition, the increase in adjusted dementia probability was 7.7% (95% CI, 0.55%-14.2%) higher in the pain group.
These findings suggest that, along with the direct treatment implications of asking patients about pain, such discussions could provide clinicians the opportunity “introduce mitigation strategies—such as assistive devices or other physical or occupational therapy interventions to address pain-related functional limitations, or self-efficacy and mindfulness strategies to reduce the affective impact of chronic pain,” the researchers concluded.
Again, these researchers are implying that chronic pain is a psychological issue that can be managed just by mindfulness.
References
Whitlock EL, Diaz-Ramirez LG, Glymour MM, Boscardin WJ, Covinsky KE, Smith AK. Association between persistent pain and memory decline and dementia in a longitudinal cohort of elders [published online June 5, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.1622
Mäntyselkä PT, Turunen JH, Ahonen RS, Kumpusalo EA. Chronic pain and poor self-rated health. JAMA. 2003;290(18):2435-2442. doi:10.1001/jama.290.18.2435
Elliott AM, Smith BH, Hannaford PC, Smith WC, Chambers WA. The course of chronic pain in the community: results of a 4-year follow-up study. Pain. 2002;99(1-2):299-307. doi:10.1016/S0304-3959(02)00138-0
Shega JW, Weiner DK, Paice JA, et al. The association between noncancer pain, cognitive impairment, and functional disability: an analysis of the Canadian study of health and aging. J Gerontol A Biol Sci Med Sci. 2010;65(8):880-886. doi:10.1093/gerona/glq039
Dublin S, Walker RL, Gray SL, et al. Prescription opioids and risk of dementia or cognitive decline: a prospective cohort study. J Am Geriatr Soc. 2015;63(8):1519-1526
van der Leeuw G, Eggermont LH, Shi L, et al. Pain and cognitive function among older adults living in the community. J Gerontol A Biol Sci Med Sci. 2016;71(3):398-405. doi:10.1093/gerona/glv166
EDS and Chronic Pain News & Info 
“Again, these researchers are implying that chronic pain is a psychological issue that can be managed just by mindfulness.”
I didn’t read the text in that way. I understood it to be about particular impacts of chronic pain on cognitive function. The suggestion was that a range of therapeutic approaches could be employed, probably alongside medication – though that wasn’t stated.
The thing is, that mindfulness does work, but you have to find the space in your day to practice it. That’s near impossible if you work full time, have elderly parents, grandchildren, children etc who all look to you for support, and on top of it you’ve been ill for decades. It takes me a good 2 hours of fully engaged mindfulness practice to get proper, lasting pain relief. That means I mainly take the tablets.
At the end of the day when you are tired and strung out, trying to cook and eat a meal and do household tasks, it’s impossible. So I resort often to medication, though I do try to incorporate mindfulness in other ways such as into a lunchtime walk and other tasks. I will try any mitigation strategy. Gardening and growing food works big time for me. It almost always makes me feel better and helps me to work through severe pain and ‘lock-up’.
I have been ill with ME for 17 years. I am one of the 25%, the group that manages to carry on working. I manage not only mine but all my mother’s finances, property, taxes, £800 a week care home fees (probably about $1000), and her recovery from a severe mental health breakdown.
I can do that (well, some of the time) because I am freaking superwoman. Sometimes the veneer peels off and I have to do some serious, isolated horizontal suffering, and I’m forgetful as hell on bad days, but pass me my lycra suit and cape!
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You really are amazing! I was beginning to think you weren’t entirely human until the last sentence :-)
My problem with mindfulness is that it makes my pain feel worse. When I stop my busyness and become still to fully experience the moment, my pain becomes huge because all distraction is gone. For me, it’s better to distance myself from my pain by putting it aside mentally and focusing on something else, like writing.
I really don’t understand how being mindful and fully “feeling” my pain can be helpful.
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One more misleading Study that contains Qualifiers. They did not study the duration, Intensity or cause of the pain. It is as if they are deliberately refusing to do clear Studies, or they were seeking a certain outcome. They also very deliberately did not ask for any information on Treatment, or whether any of this group did anything to mitigate the pain. There is no mention of whether these people took Medication, had their pain treated or under control. They clearly either did nto want answers to these question or perhaps made findings that did nto fit their Agenda. It is not an accident that none of these questions were answered, or if there was a correlation with untreated pain and death.
Many of these “Studies” avoid measuring the amount of pain, duration, and cause for a reason. If they include people with occasional pain, or pain with certain activities, along with people with serious long term pain, they can further obfuscate the meaning of the Study, or draw conclusion based on their particular bias or funding.
This “Study” is Scientifically meaningless, and makes some misleading Statements. The Mitigation Strategies include Physical Therapy, Assistive Devices and Mindfulness. None of these include treating the pain itself. These “Mitigation Strategies” are not very helpful for a lot Chronic Pain Patients, yet they imply that they are. Physician will even act incredulous if a Patient reports that these interventions make the pain worse or have no effect. There are patients who will report improvement to please the Doctor or to make it appear they are participating. Here they are implying they should be introduced, which in many cases these are introduced as an alternative to treating or diagnosing the pain. Patients either give up after a while or find another Doctor and the clock starts all over again, only adding to the frustration. When these mitigations fail, the patient is made to feel like a failure, or they did not “try” hard enough.
Generally the frustration, futility of these “Strategies’ coupled with the Physicians deliberate misunderstanding when they don’t work, only increases the stress and alienation of people with pain. It is very telling that they don’t study this. The refusal to include certain information in these “Studies” this is done by design, so they can attribute any perceived benefits to these “Treatments.” Someone with minimal occasional pain might feel as if these mitigations helped,while a person with a more serious pain condition would find they made it worse, and discontinue these “Mitigation Strategies.” It is really no wonder people are losing faith in Science. Studies like this can be used to peddle anything. Psychologists in their zeal to cash in on the desperate people with pain, use these vague and biased “Studies” to insert themselves into treating a Physical Problem.
There are quite a few that “Believe pain is a Psychological Problem, their Income depends on it. They are very good at manipulating already frustrated and scorned Patients, that they are in pain because there is something intrinsically wrong with them. Even with obvious Physical Injuries, it is still in the Psychologists Career and Financial Interest to keep them coming back. They are an easy out for Doctors avoiding Liability, and insurance Companies obfuscating a condition so they can deny care. Even attributing a small percentage of failed Surgeries or on the Job Injuries, to “Psychological Problems” can mean millions in Profits, and avoided Liability. In Post Fact America, where people believe in the Mind Body connection or the misleading pseudo Science in Major Media, it was easy to dupe the gullible.
Even Returning Veterans with Horrific Injuries are being forced to go through these “Mitigation Strategies” as their Untreated Pain gets worse. That has been effectively censored by Mass Media, they only show the few Outliers, the ones who run Marathons, or have a place on the Corporate Ladder. They only mention PTSD, a Psychological Issue, as if they were not injured at all. Once PTSD is mentioned everything else doesn’t matter, because they are “Mentally Ill’ a condition that is easy to ignore.
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Well, I find if you focus on breathing through the pain, and stay with that breathing until you do that, it lessens. I first started yoga and mindfulness (though it wasn’t called that then) when I was 16. I’m 62 now, so I’ve kind of got the hang of it. I am with you about what sometimes happens when there are no distractions – my work is a delightful if exhausting distraction. The thing is, perhaps your writing is a form of mindfulness, one that works for you. We are all different, and the strategies that work for us will be different. But keep trying, and keep focused on the breathing, or the taking steps during a walk, or looking up at the clouds or stars, anywhere but in your messed up body or head. Connect. Breathe. If it doesn’t work – collapse…
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Thanks for your encouragement!
You’re right, I need to find the kind of mindfulness that works for me. As with all else, sweeping generalizations of some simplistic “mindfulness” techniques are being presented as a “cure” for our pain.
If it was that darn easy to conquer, I wouldn’t be taking “high” doses of opioids to control my pain in the first place!
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