Chronic Pain Accelerates Dementia — Pain News Network – By Dr. Lynn Webster, PNN Columnist – Sep 2019
In 2017, JAMA Internal Medicine published a study that found older people with chronic pain experience faster declines in memory and are more likely to develop dementia.
While prior research had shown a link between chronic pain and brain damage, this was one of the first studies to specifically suggest that chronic pain can cause dementia.
I have a whole list of posts about the wide-ranging mental and physical damages of chronic pain: Bodily Damage from Uncontrolled Chronic Pain
The authors reported that people aged 60 and over with persistent pain experienced a 9.2% more rapid decline in memory score when compared to people of the same age without chronic pain.
There are an estimated 20 million Americans with high impact (the most severe) chronic pain who may be experiencing accelerated decline in cognition due to their pain.
The amount of dementia appears to be associated with the severity and duration of chronic pain.
Undertreated or untreated chronic pain may accelerate dementia.
Chronic pain affects an even larger percentage of elderly adults (one in three) than the general population. Since the prevalence of chronic pain increases with age, the probability of experiencing dementia increases as well. However, the reasons for that go beyond aging itself.
Seniors are more likely to take multiple medications that can contribute to mental confusion. On average, elderly people take five or more prescriptions. They may also use over-the-counter medications, which adds to potential drug-associated mental compromise.
Opioids, in particular, have been implicated in cognitive impairment. However, a study published in 2016 suggests there is no difference in cognitive decline between people on opioids and those on nonsteroidal anti-inflammatory drugs.
From personal experience, I can say that pain definitely leads to “cognitive impairment” because it constantly interrupts my thinking. As I sit here typing, trying to focus on what I’m trying to write, little jabs of pain catch me by surprise and various growing pressure pains force me to move around.
Sometimes I end up kneeling instead of sitting to type, or turning my chair around and leaning over it to type, or bringing one foot up onto the chair as I type.
These movements change the direction of the gravitational pull on my joints, which relieves pressure where it eventually becomes painful. I get several minutes of relief before the pressure pain builds up elsewhere, and then I move again, over and over.
It’s easy to see how “cognitive impairment” results from all these interruptions.
The study’s implication is that pain, not opioids, leads to cognitive impairment.
Chronic pain appears to affect the function and structure of the hippocampus. This is the region of the brain that involves learning, memory, and emotional processing.
One explanation for the mental decline associated with chronic pain is that various areas of the brain compete for attention.
Attentional impairment compromises memory by diverting attention to the areas of the brain processing pain.
In effect, the brain is multi-tasking and favoring the processing of pain over cognition. This may, in part, explain the clinical phrase “brain fog.”
That has certainly been my experience. Our body’s main goal is to stay alive, so pain signals have a higher priority than just concentrating on reading or writing (or thinking).
I’m delighted every time they find an explanation for one of my symptoms because it’s often just as I imagined it.
The Australian Broadcasting Company’s “All in the Mind” website explains that pain damages the brain in several ways, including a change in the size of the thalamus and a decrease in the amount of a neurotransmitter (gamma-aminobutyric acid) the brain produces. In other words, chronic pain changes the brain structurally and functionally.
Over time, brains damaged by pain lose the ability to handle pain — along with some of the personality attributes that make us who we are.
This shows exactly how damaging the new opioid restrictions are to patients. If effective pain relief is only achieved with opioids, then refusing to prescribe them would lead to brain damage and dementia.
Brain Damage Can Be Reversed
The good news is that the brain damage caused by chronic pain can be reversed, at least to some extent. Unfortunately, the elderly are less likely to recover from dementia caused by chronic pain as compared with younger patients.
If pain is adequately treated, the brain may be able to regain its ability to function normally. A 2009 study of patients with chronic pain due to hip osteoarthritis showed reversal of brain changes when their pain was adequately treated.
With the current anti-opioid rules/regulations/restrictions, even if some patients can only achieve sufficient pain relief from opioids, doctors are not allowed to prescribe them and are forced to leave their patients in pain and suffering all the damage caused by it.
In normal times, this would be a clear indication of malpractice, but these days they are praised for lowering opioid doses, no matter what the consequences.
If the dangers of untreated pain were advertised and feared as much as addiction, aggressive pain relief would be the norm.
Author: Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is author of the award-winning book, “The Painful Truth,” and co-producer of the documentary, “It Hurts Until You Die.” You can find him on Twitter: @LynnRWebsterMD.