Article thumbnail

Neurodegenerative Properties of Chronic Pain: Cognitive Decline in Patients with Chronic Pancreatitis

By Marijtje L. A. Jongsma, Simone A. E. Postma, Pierre Souren, Martijn Arns, Evian Gordon, Kris Vissers, Oliver Wilder-Smith, Clementina M. van Rijn and Harry van Goor

Abstract

Chronic pain has been associated with impaired cognitive function. We examined cognitive performance in patients with severe chronic pancreatitis pain. We explored the following factors for their contribution to observed cognitive deficits: pain duration, comorbidity (depression, sleep disturbance), use of opioids, and premorbid alcohol abuse. The cognitive profiles of 16 patients with severe pain due to chronic pancreatitis were determined using an extensive neuropsychological test battery. Data from three cognitive domains (psychomotor performance, memory, executive functions) were compared to data from healthy controls matched for age, gender and education. Multivariate multilevel analysis of the data showed decreased test scores in patients with chronic pancreatitis pain in different cognitive domains. Psychomotor performance and executive functions showed the most prominent decline. Interestingly, pain duration appeared to be the strongest predictor for observed cognitive decline. Depressive symptoms, sleep disturbance, opioid use and history of alcohol abuse provided additional explanations for the observed cognitive decline in some of the tests, but to a lesser extent than pain duration. The negative effect of pain duration on cognitive performance is compatible with the theory of neurodegenerative properties of chronic pain. Therefore, early and effective therapeutic interventions might reduce or prevent decline in cognitive performance, thereby improving outcomes and quality of life in these patients

Topics: Research Article
Publisher: Public Library of Science
OAI identifier: oai:pubmedcentral.nih.gov:3158076
Provided by: PubMed Central

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.

Suggested articles

Citations

  1. (2007). A re-examination of pain-cognition interactions: implications for neuroimaging.
  2. (2006). Affective components and intensity of pain correlate with structural differences in gray matter in chronic back pain patients.
  3. (2007). Alcohol: effects on neurobehavioral functions and the brain.
  4. (2002). An overview of neuropathic pain: syndromes, symptoms, signs, and several mechanisms. The Clinical journal of pain 18:
  5. (2002). Attentional functioning in fibromyalgia, rheumatoid arthritis, and musculoskeletal pain patients. Arthritis and rheumatism 47:
  6. (2004). Chronic back pain is associated with decreased prefrontal and thalamic gray matter density.
  7. (1995). Chronic pain and distraction: an experimental investigation into the role of sustained and shifting attention in the processing of chronic persistent pain. Behaviour research and therapy 33:
  8. (2000). Chronic pain and neuropsychological functioning.
  9. (2004). Chronic pain patients are impaired on an emotional decision-making task.
  10. (2010). Chronic pancreatitis and its effect on employment and health care experience: results of a prospective American multicenter study.
  11. (2006). Chronic pancreatitis patients show hyperalgesia of central origin: a pilot study.
  12. (2001). Chronic pancreatitis: diagnosis, classification, and new genetic developments.
  13. (1997). Chronic pancreatitis.
  14. (2001). Cognitive function in fibromyalgia patients.
  15. (2003). Cognitive function in people with chronic illness: inflammatory bowel disease and irritable bowel syndrome.
  16. (1991). Cognitive impairment in musculoskeletal pain patients.
  17. (2006). Cognitive performance in longterm abstinent alcoholic individuals. Alcoholism, clinical and experimental research 30:
  18. (2001). Conscious and automatic uses of memory in chronic pain patients.
  19. (2005). Dynamics and pathology of dendritic spines.
  20. (2008). Executive function. Current biology:
  21. (2004). Factors associated with health-related quality of life in chronic pancreatitis.
  22. (2005). Gray matter decrease in patients with chronic tension type headache.
  23. (2000). Impaired neuropsychological performance in chronic nonmalignant pain patients receiving long-term oral opioid therapy.
  24. (2008). Is the pain in chronic pancreatitis of neuropathic origin? Support from EEG studies during experimental pain. World journal of gastroenterology:
  25. (2008). Limited effect of thoracoscopic splanchnicectomy in the treatment of severe chronic pancreatitis pain: a prospective long-term analysis of 75 cases.
  26. (2010). Long-term quality of life after surgery for chronic pancreatitis. The British journal of surgery 97:
  27. (2007). Manifestations of early brain recovery associated with abstinence from alcoholism. Brain: a journal of neurology 130:
  28. Meijer E Handbook of Multilevel Analysis:
  29. (2011). Memory functions in chronic pain: examining contributions of attention and age to test performance. The Clinical journal of pain 27:
  30. (2006). Memory impairment in patients with late-onset major depression: the effect of antidepressant therapy.
  31. (2005). Monitoring the effects of chronic alcohol consumption and abstinence on brain metabolism: a longitudinal proton magnetic resonance spectroscopy study.
  32. (1999). Multi-level analysis: An introduction to basic and advanced multi-level modeling. London: Sage Publications.
  33. (2004). Multilevel modelling; Bryman
  34. (2009). Neurocognitive consequences of sleep deprivation.
  35. (2000). Neuronal plasticity: increasing the gain in pain.
  36. (2005). Neuropsychological assessment of chronic non-malignant pain patients treated in a multidisciplinary pain centre. European journal of pain 9:
  37. (2003). Neuropsychological impairment in fibromyalgia: relation to depression, fatigue, and pain.
  38. (2000). Neuropsychological performance in cancer patients: the role of oral opioids, pain and performance status.
  39. (2008). Neuropsychological performance in persons with chronic fatigue syndrome: results from a population-based study.
  40. (2011). Pain and the brain: specificity and plasticity of the brain in clinical chronic pain.
  41. (2002). Pain management in chronic pancreatitis.
  42. (2011). Pain mechanisms in chronic pancreatitis: of a master and his fire. Langenbeck’s archives of surgery/Deutsche Gesellschaft fur
  43. (2002). Pfefferbaum A
  44. (2006). Pharmacological management of pain in chronic pancreatitis. Digestive and liver disease:
  45. (2006). Quality of life in chronic pancreatitis. World journal of gastroenterology:
  46. (2004). Recovery of short-term memory and psychomotor speed but not postural stability with long-term sobriety in alcoholic women.
  47. (2001). Reduced neuropsychologic measures as predictors of treatment outcome in patients with temporomandibular disorders.
  48. (2010). Regional gray matter density changes in brains of patients with irritable bowel syndrome.
  49. (2009). Review of cognitive dysfunction in fibromyalgia: a convergence on working memory and attentional control impairments. Rheumatic diseases clinics of
  50. (2001). Sex differences in negative emotional responses to chronic pain. The journal of pain:
  51. (2006). Shared mechanisms between chronic pain and neurodegenerative disease.
  52. (1995). The attentional control of pain: methodological and theoretical concerns.
  53. (2006). The neuropsychological profile of psychotic major depression and its relation to cortisol.
  54. (2001). The relationship between depression and cognition. Archives of gerontology and geriatrics Supplement
  55. (2006). The relationship between pain, neuropsychological performance, and physical function in community-dwelling older adults with chronic low back pain.
  56. (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. The British journal of clinical psychology/the
  57. (2009). Towards a theory of chronic pain.
  58. (1998). Weighting for unequal selection probabilities in multilevel models.
  59. (2005). Working through the pain: a controlled study of the impact of persistent pain on performing a computer task. The Clinical journal of pain 21: