Pain and dementia


Baptist Health Experts Dissect Study Linking Chronic Pain to Dementia

Could there be a link between chronic pain, defined as pain that lingers for more than three months, and risk of dementia? A new study suggests that people with chronic pain in multiple parts of the body -- or “multisite” -- have a higher risk of dementia and may experience more significant cognitive decline, including loss of memory and the ability to learn, compared to those with single-site chronic pain.

Multisite chronic pain affects nearly half of chronic pain patients. And it puts a greater burden on their overall health and day-to-day living.

Akshay Goyal, M.D., a pain management physician at Baptist Health Miami Neuroscience Institute.


The study, published in the journal Proceedings of the National Academy of Sciences, or PNAS, analyzed data on more than 9,000 people who had undergone brain scans as part of the U.K. Biobank, a long-term government study of more than 500,000 participants in the United Kingdom between the ages of 40 and 69.

Researchers focused on the hippocampus, the complex brain structure embedded deep into the temporal lobe which plays a major role in learning and memory. The hippocampus in people with multisite chronic pain shrank faster, the study found.

“I find it interesting how the authors made a distinction between the effects of single-site versus multisite chronic pain in the study,” said Akshay Goyal, M.D., a pain management physician at Baptist Health Miami Neuroscience Institute. “They are proposing the idea that someone with chronic neck and back pain is likely to experience more rapid cognitive decline over someone who suffers only from chronic back pain.”

There have been no previous studies linking dementia and multisite chronic pain, points out Seif Elbualy, M.D., director of interventional pain management at Baptist Health Marcus Neuroscience Institute.

Seif Elbualy, M.D., director of interventional pain management at Baptist Health Marcus Neuroscience Institute.


“This retrospective study brings up interesting points regarding the development of dementia in association with the presence of chronic pain,” said Dr. Elbualy. “It also raised interesting points regarding the hippocampus size and function. However, these changes can be from dementia alone as well as other stressors. More research is necessary to further specify the linkage.”

The study controlled for a range of contributing conditions — including age, alcohol use, body mass, ethnicity, genetics, history of cancer, diabetes, vascular or heart problems, medications, psychiatric symptoms and smoking. However, researchers did not control for levels of exercise. Healthcare experts and many studies have linked regular exercise to lowering a person’s risk of dementia. For many individuals, exercise can also help alleviate or eliminate chronic pain.

“Though many demographics were accounted for, the amount of exercise was not controlled for in this study,” explains Dr. Goyal. “There is a growing body of evidence that exercise may be the most powerful tool we have at our disposal to combat cognitive decline.”

Chronic pain sufferers are often at a higher risk for other health issues, including cognitive decline, the physicians emphasize. A study published by the National Institutes of Health (NIH) found that chronic pain often occurs in the elderly, particularly in the patients with neurodegenerative disorders such as Alzheimer’s disease.

“In general, patients who suffer from any type of chronic pain likely have a decrease in functionality which in turn places them at higher risk for cognitive deterioration,” said Dr. Goyal. “In an article in the Journal of Neuroinflammation, the authors found that the prevalence of chronic pain in Alzheimer’s Disease patients was as high as 45.8 percent, and this percentage may even be an underestimation.”

Patients with chronic pain should seek medical treatment, which may include a plan of physical rehabilitation or regular exercise, the physicians said.

“The study should increase the impetus for patients to seek out treatment for chronic pain to improve their lives in many different ways,” said Dr. Elbualy.

Healthcare that Cares

With internationally renowned centers of excellence, 12 hospitals, more than 27,000 employees, 4,000 physicians and 200 outpatient centers, urgent care facilities and physician practices spanning across Miami-Dade, Monroe, Broward and Palm Beach counties, Baptist Health is an anchor institution of the South Florida communities we serve.

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