Contact heat sensitivity and reports of unpleasantness in communicative people with mild to moderate cognitive impairment in Alzheimer’s disease: a cross-sectional study
Background:
Compared to healthy controls, people with Alzheimer’s disease (AD) have been shown to receive less pain medication and report pain less frequently. It is unknown if these findings reflect less perceived pain in AD, an inability to recognize pain, or an inability to communicate pain.
Methods:
To further examine aspects of pain processing in AD, we conducted a cross-sectional study of sex-matched adults ≥65 years old with and without AD (AD: n = 40, female = 20, median age = 75; control: n = 40, female = 20, median age = 70) to compare the psychophysical response to contact-evoked perceptual heat thresholds of warmth, mild pain, and moderate pain, and self-reported unpleasantness for each percept.
Results:
When compared to controls, participants with AD required higher temperatures to report sensing warmth (Cohen’s d = 0.64, p = 0.002), mild pain (Cohen’s d = 0.51, p = 0.016), and moderate pain (Cohen’s d = 0.45, p = 0.043). Conversely, there were no significant between-group differences in unpleasantness ratings (p > 0.05).
Conclusions:
The between-group findings demonstrate that when compared to controls, people with AD are less sensitive to the detection of thermal pain but do not differ in affective response to the unpleasant aspects of thermal pain. These findings suggest that people with AD may experience greater levels of pain and potentially greater levels of tissue or organ damage prior to identifying and reporting injury. This finding may help to explain the decreased frequency of pain reports and consequently a lower administration of analgesics in AD.
Keywords:
Pain, Dementia, Alzheimer’s disease, Unpleasantness, Psychophysics
Autoři:
Todd B. Monroe 1*; Stephen J. Gibson 2; Stephen P. Bruehl 3; John C. Gore 4; Mary S. Dietrich 5; Paul Newhouse 6; Sebastian Atalla 1; Ronald L. Cowan 7
Působiště autorů:
Vanderbilt University School of Nursing, Vanderbilt University Institute of Imaging Science, Vanderbilt Psychiatric Neuroimaging Program, Nashville, Tennessee, USA.
1; National Ageing Research Institute, Royal Melbourne Hospital, PO Box 212 , Melbourne, VIC 0 0, Australia.
2; Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
3; Vanderbilt University Institute of Imaging Science, Nashville, Tennessee, USA.
4; Vanderbilt Psychiatric Neuroimaging Program, Vanderbilt University Schools of Medicine and Nursing, Nashville, Tennessee, USA.
5; Vanderbilt Center for Cognitive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
6; Vanderbilt Psychiatric Neuroimaging Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
7
Vyšlo v časopise:
BMC Medicine 2016, 14:74
Kategorie:
Research article
prolekare.web.journal.doi_sk:
https://doi.org/10.1186/s12916-016-0619-1
© 2016 Monroe et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
The electronic version of this article is the complete one and can be found online at: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0619-1
Souhrn
Background:
Compared to healthy controls, people with Alzheimer’s disease (AD) have been shown to receive less pain medication and report pain less frequently. It is unknown if these findings reflect less perceived pain in AD, an inability to recognize pain, or an inability to communicate pain.
Methods:
To further examine aspects of pain processing in AD, we conducted a cross-sectional study of sex-matched adults ≥65 years old with and without AD (AD: n = 40, female = 20, median age = 75; control: n = 40, female = 20, median age = 70) to compare the psychophysical response to contact-evoked perceptual heat thresholds of warmth, mild pain, and moderate pain, and self-reported unpleasantness for each percept.
Results:
When compared to controls, participants with AD required higher temperatures to report sensing warmth (Cohen’s d = 0.64, p = 0.002), mild pain (Cohen’s d = 0.51, p = 0.016), and moderate pain (Cohen’s d = 0.45, p = 0.043). Conversely, there were no significant between-group differences in unpleasantness ratings (p > 0.05).
Conclusions:
The between-group findings demonstrate that when compared to controls, people with AD are less sensitive to the detection of thermal pain but do not differ in affective response to the unpleasant aspects of thermal pain. These findings suggest that people with AD may experience greater levels of pain and potentially greater levels of tissue or organ damage prior to identifying and reporting injury. This finding may help to explain the decreased frequency of pain reports and consequently a lower administration of analgesics in AD.
Keywords:
Pain, Dementia, Alzheimer’s disease, Unpleasantness, Psychophysics
Zdroje
1. Monroe TB, Misra SK, Habermann RC, Dietrich MS, Cowan RL, Simmons SF. Pain reports and pain medication treatment in nursing home residents with and without dementia. Geriatr Gerontol Int. 2013;14(3):541–8.
2. Monroe TB, Carter MA, Feldt KS, Dietrich MS, Cowan RL. Pain and hospice care in nursing home residents with dementia and terminal cancer. Geriatr Gerontol Int. 2013;13(4):1018–25.
3. Morrison RS, Magaziner J, McLaughlin MA, Orosz G, Silberzweig SB, Koval KJ, et al. The impact of post-operative pain on outcomes following hip fracture. Pain. 2003;103(3):303–11.
4. Haasum Y, Fastbom J, Fratiglioni L, Kareholt I, Johnell K. Pain treatment in elderly persons with and without dementia: a population-based study of institutionalized and home-dwelling elderly. Drugs Aging. 2011;28(4):283–93.
5. Kunz M, Mylius V, Scharmann S, Schepelman K, Lautenbacher S. Influence of dementia on multiple components of pain. Eur J Pain. 2009;13(3):317–25.
6. Horgas AL, Elliott AF, Marsiske M. Pain assessment in persons with dementia: relationship between self-report and behavioral observation. J Am Geriatr Soc. 2009;57(1):126–32.
7. Hargreaves K, Dubner R, Brown F, Flores C, Joris J. A new and sensitive method for measuring thermal nociception in cutaneous hyperalgesia. Pain. 1988;32(1):77–88.
8. Price DD, Riley JL, Wade JB. Psychophysical approaches to measurement of the dimensions and stages of pain. In: Turk D, Melzack R, editors. Handbook of Pain Assessment. 2nd ed. New York: Guilford Press; 2001. p. 53–75.
9. Melzack R, Casey KL. Sensory, motivational, and central control determinants of pain. In: Kenshalo DR, Thomas CC, editors. The Skin Senses. Springfield, IL: Thomas; 1968. p. 423–43.
10. Jensen-Dahm C, Madsen CS, Waldemar G, Ballegaard M, Hejl A-M, Johnsen B, et al. Contact heat evoked potentials (CHEPs) in patients with mild-moderate Alzheimer’s disease and matched control: a pilot study. Pain Med. 2015;17(4):675–84.
11. Jensen-Dahm C, Werner M, Ballegaard M, Jensen TS, Waldemar G. Stimulusresponse function to heat pain in patients with mild-moderate Alzheimer’s disease. Alzheimers Dement. 2014;10(4):532.
12. Rainero I, Vighetti S, Bergamasco B, Pinessi L, Benedetti F. Autonomic responses and pain perception in Alzheimer’s disease. Eur J Pain. 2000;4(3):267–74.
13. Benedetti F, Arduino C, Vighetti S, Asteggiano G, Tarenzi L, Rainero I. Pain reactivity in Alzheimer patients with different degrees of cognitive impairment and brain electrical activity deterioration. Pain. 2004;111(1–2):22–9.
14. Kunz M, Scharmann S, Hemmeter U, Schepelmann K, Lautenbacher S. The facial expression of pain in patients with dementia. Pain. 2007;133(1–3):221–8.
15. Gibson SJ, Voukelatos X, Ames D, Flicker L, Helme RD. An examination of pain perception and cerebral event-related potentials following carbon dioxide laser stimulation in patients with Alzheimer’s disease and agematched control volunteers. Pain Res Manag. 2001;6(3):126–32.
16. Benedetti F, Vighetti S, Ricco C, Lagna E, Bergamasco B, Pinessi L, et al. Pain threshold and tolerance in Alzheimer’s disease. Pain. 1999;80(1–2):377–82.
17. Cole LJ, Farrell MJ, Duff EP, Barber JB, Egan GF, Gibson SJ. Pain sensitivity and fMRI pain-related brain activity in Alzheimer’s disease. Brain. 2006; 129(Pt 11):2957–65.
18. Lints-Martindale AC, Hadjistavropoulos T, Barber B, Gibson SJ. A psychophysical investigation of the facial action coding system as an index of pain variability among older adults with and without Alzheimer’s disease. Pain Med. 2007;8(8):678–89.
19. Beach PA, Huck JT, Miranda MM, Foley KT, Bozoki AC. Effects of Alzheimer’s disease on the facial expression of pain. Clin J Pain. 2015 [Epub ahead of print]. doi: 10.1097/AJP.0000000000000302
20. Defrin R, Amanzio M, de Tommaso M, Dimova V, Filipovic S, Finn DP, et al. Experimental pain processing in individuals with cognitive impairment: current state of the science. Pain. 2015;156(8):1396–408.
21. Folstein MF, Folstein SE, McHugh PR. “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.
22. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9.
23. Reisberg B. Functional assessment staging (FAST). Psychopharmacol Bull. 1988;24(4):653–9.
24. Dubois B, Feldman HH, Jacova C, Dekosky ST, Barberger-Gateau P, Cummings J, et al. Research criteria for the diagnosis of Alzheimer’s disease: revising the NINCDS-ADRDA criteria. Lancet Neurol. 2007;6(8):734–46.
25. Jeste DV, Palmer BW, Appelbaum PS, Golshan S, Glorioso D, Dunn LB, et al. A new brief instrument for assessing decisional capacity for clinical research. Arch Gen Psychiatry. 2007;64(8):966–74.
26. Hollingshead AB. Four factor index of social status. New Haven: Yale University; 1975.
27. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994;23(2):129–38.
28. Kurlowicz L. The Geriatric Depression Scale (GDS). J Gerontol Nurs. 1999;25(7):8–9.
29. Spielberger R, Gorsuch R, Lushene R. State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists; 1970.
30. Monroe TB, Gore JC, Bruehl SP, Benningfield MM, Dietrich MS, Chen LM, et al. Sex differences in psychophysical and neurophysiological responses to pain in older adults: a cross-sectional study. Biol Sex Differ. 2015;6(25):1–20.
31. Medoc Advanced Medical Systems. Pathway Pain & Sensory Evaluation System. Durham, NC: Medoc Ltd. Advanced Medical Systems; 2006. p. 3.
32. Price DD, Bush FM, Long S, Harkins SW. A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales. Pain. 1994;56(2):217–26.
33. Cole LJ, Farrell MJ, Gibson SJ, Egan GF. Age-related differences in pain sensitivity and regional brain activity evoked by noxious pressure. Neurobiol Aging. 2010;31(3):494–503.
34. Cole LJ, Gavrilescu M, Johnston LA, Gibson SJ, Farrell MJ, Egan GF. The impact of Alzheimer’s disease on the functional connectivity between brain regions underlying pain perception. Eur J Pain. 2011;15(6):568.e1–11.
35. Petzke F, Gracely RH, Park KM, Ambrose K, Clauw DJ. What do tender points measure? Influence of distress on 4 measures of tenderness. J Rheumatol. 2003;30(3):567–74.
36. Scherder EJ, Sergeant JA, Swaab DF. Pain processing in dementia and its relation to neuropathology. Lancet Neurol. 2003;2(11):677–86.
37. Scherder E, Bouma A, Slaets J, Ooms M, Ribbe M, Blok A, et al. Repeated pain assessment in Alzheimer’s disease. Dement Geriatr Cogn Disord. 2001;12(6):400–7.
38. Scherder E, Bouma A, Borkent M, Rahman O. Alzheimer patients report less pain intensity and pain affect than non-demented elderly. Psychiatry. 1999;62(3):265–72.
39. Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1975;1(3):277–99.
Článok vyšiel v časopise
BMC Medicine
2016 Číslo 74
- Metamizol jako analgetikum první volby: kdy, pro koho, jak a proč?
- Nejasný stín na plicích – kazuistika
- Masturbační chování žen v ČR − dotazníková studie
- Je Fuchsova endotelová dystrofie rohovky neurodegenerativní onemocnění?
- Fixní kombinace paracetamol/kodein nabízí synergické analgetické účinky
Najčítanejšie v tomto čísle