Neuropsychological assessment of chronic non‐malignant pain patients treated in a multidisciplinary pain centre

Abstract

The aim of the study was to investigate the influence of pain, sedation, pain medications and socio-demographics on cognitive functioning in chronic non-malignant pain patients. Chronic non-malignant pain patients (N=91) treated in a multidisciplinary pain centre were compared with age and sex matched healthy volunteers (N=64). Furthermore four subgroups of patients were examined: Group 1 (N=21) received no pain medications, group 2 (N=19) were in long-term oral opioid treatment, group 3 (N=18) were treated with antidepressants and/or anticonvulsants and group 4 (N=33) were treated with a combination of long-term oral opioids and antidepressants and/or anticonvulsants. Assessments comprised pain (PVAS) and sedation (SVAS), Continuous Reaction Time (CRT) testing for sustained attention, Finger Tapping Test (FTT) testing for psychomotor speed, Paced Auditory Serial Addition Task (PASAT) testing for information processing and working memory and Mini Mental State Examination (MMSE). CRT and FTT were impaired in the total patient sample. Treatment with opioids was associated with poorer performance of PASAT. High scores of PVAS and SVAS were associated with poor performance of PASAT and CRT, respectively. MMSE seems to be too insensitive for detecting the milder forms of cognitive impairment found in chronic non-malignant patients.

The effect of pain on cognitive function: A review of clinical and preclinical research

“…Chronic pain patients display slower reaction times than matched controls in a variety of standardised cognitive tests (Alanoglu et al, 2005;Antepohl et al, 2003;Biessels et al, 2007;Calandre et al, 2002;Harman and Ruyak, 2005;Sjogren et al, 2005), in particular on tests related to psychomotor ability (Harman and Ruyak, 2005;Lee et al, 2010;Ryan, 2005;Ryan et al, 1993;Ryan et al, 1992). Impaired perceptual learning ability has also been shown in chronic pain patients (Maihofner and DeCol, 2007).…”

“…Of the clinical studies outlined in Table 1, only one study controlled fully for the effects of medication by including a non-medicated comparison group as well as drug-treated groups (Sjogren et al, 2005).…”

Neuropsychological Complications of HIV Disease and Substances of Abuse

“…Some may even suffer loss of spontaneous movement, similar to Parkinson's disease [27][28][29] . Opiates have been found to induce impairments in the areas of attention, information processing, problem solving, coordination, working memory and psychomotor speed and performance [30][31][32][33][34] . Furthermore, research indicates that opiate users in methadone maintenance may have significantly more neuropsychological impairment than those in treatment, suggesting that methadone exacerbates cognitive dysfunction in opiate users [35] .…”

Comparison of the cognitive performance of elderly caregivers with and without chronic pain

“…In contrast, the authors of another study observed that the MMSE test is not effective in proving cognitive deficit in patients with chronic pain. The researchers conducted a cross-sectional study to investigate the influence of pain, sedation, medications and sociodemographic characteristics on the cognitive functioning of adult and elderly patients with chronic pain, noting that the MMSE was not the most adequate instrument to detect milder forms of cognitive impairment in patients with chronic pain (24) . In the present study, it was not possible to observe statistical differences in the cognitive domains between the two groups, disagreeing with studies found in the literature and contrary to the initial hypothesis.…”