A new literature review study from researchers at the University of Tel Aviv has found that people with dementia and other forms of cognitive impairment have altered responses to pain, with many conditions associated with increased pain sensitivity. The researched findings question the previous notion that people with cognitive impairment have reduced pain sensitivity to pain. Rather, it appears that those with widespread brain atrophy or neural degeneration all show increased pain responses and/or greater pain sensitivity in the current study.
The team analyzed previous studies on pain responses in cognitively impaired patients. The researchers state that the topic is an important one, as many patients with cognitive impairment, which can result from a wide range of neurological and neurodegenerative diseases, or even normal aging, have sustained and complex healthcare needs involving pain.
However, the team explain that individuals with cognitive impairment can have difficulty communicating the features of their pain, which in turn presents a significant challenge for effective diagnosis and treatment of their pain. Because of those communication issues, it has even been suggested that cognitively impaired people have reduced pain sensitivity. The researchers believe that understanding the experience and responses to pain in people with cognitive impairment is an imperative ethical goal.
The findings of the literature review suggests that even normal, healthy aging may be associated with increased vulnerability to pain, as well as slightly reduced cognitive performance. The team hypothesize that these changes may set up a vicious circle, with pain leading to a decline in cognitive function and vice versa. The previous studies suggest that the experience of pain is elevated in patients with mild to moderate Alzheimer’s disease. Pain sensitivity in late Alzheimer’s disease is unclear; the team emphasize the need for multi-method approaches to assessing pain in this group of patients.
The mined results showed that the effects of other types of neurodegenerative impairment on pain processing appear variable. Pain responses seem to be decreased in patients 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.
The team state that various developmental disabilities, such as autism, cerebral palsy, and intellectual disability, are associated with increased pain sensitivity. As in other groups of patients with communication difficulties, alternative ways of assessing pain are needed. Pain processing also appears to be affected in patients with various types of brain damage, such as stroke and traumatic brain injury. Recent studies have demonstrated brain responses to pain stimuli even in severely brain-damaged patients in a vegetative state.
Within the limitations of the studies performed to date, the researchers surmise that overall the analysis suggests that pain processing is frequently altered in cognitively impaired individuals, often with increased sensitivity to painful stimuli. The team hope their review will increase awareness of possible changes in pain perception and processing and promote better approaches to pain management in people living with cognitive impairment.
Source: Wolters Kluwer
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