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Average intensity from VAS scale: 6.46 (SD: 2.118)
COGNITIVE IMPAIRMENT AND ASSOCIATED FACTORS IN
PATIENTS WITH CHRONIC PAIN. PRELIMINARY RESULTS Ojeda B1,2, Dueñas M1,2, Salazar A1,2, Torres LM2,4, Sánchez-Magro I3, Failde I1,2 1 Department of Preventive Medicine and Public Health, University of Cádiz, Spain, 2External Chair of Pain Grünenthal Fundation-University of Cádiz,
3Medical Department-Grünenthal Fundation, 4University Hospital “Puerta del Mar”, Cádiz, Spain.
Methods
Abstract
Objectives
Results
Conclusions
References
1.
Povedano, M., J. Gascón, R. Gálvez, M. Ruiz & J. Rejas (2007) Cognitive Function Impairment in Patients with Neuropathic Pain Under Standard Conditions of Care. Journal of Pain and Symptom Management, 33, 78-89.
2.
Rodríguez-Andreu, J., R. Ibáñez-Bosch, A. Portero-Vázquez, X. Masramón, J. Rejas & R. Gálvez (2009) Cognitive impairment in patients with Fibromyalgia syndrome as assessed by the mini-mental state examination. BMC Musculoskeletal Disorders, 10: 162.
To compare cognitive function in patients with chronic pain and patients suffering from non painful processes. To identify those variables linked to cognitive impairment in patients with chronic pain.
In addition to a sensory phenomenon, chronic pain presents other dimensions such as the affective-emotional or cognitive. In patients with chronic pain, the normal functioning of these dimensions is disturbed, leading to depression and cognitive impairment in many cases. The evaluation and management of these problems, which often occur in parallel, must be taken into account in order to achieve a comprehensive approach to patients with chronic pain.
MMSE results were lower in those patients with chronic pain included in the research than those in controls. These marks are more related to some factors such as depression and education studies than to pain peculiarities. Identification and right treatment of depression in patients with pain is a factor to take into account in order to control their cognitive function.
Cross-sectional study in 213 patients with different chronic pain characteristics, treated at the pain unit of a University Hospital (cases); and 29 patients treated in a medical centre due to non painful conditions (controls). The Spanish version of MiniMentalState (MMS) was used for cognitive evaluation. Depression and anxiety were assessed by the Hospital Anxiety and Depression scale (HADs). The MOS Sleep scale and the Visual Analogue Scale (VAS) were undertaken to valuate sleep characteristics and pain intensity, respectively. Sociodemographic and clinic information was collected through a structured questionnaire. Two-dimensional analyses were carried out with the objective of finding out differences between cases and controls. A linear regression model was used to identify variables associated with the MMS score in patients with pain.
Printed by
Cases (n=213)
Controls (n=29)
p
Male
Female
38.0
62.0
37.9
62.1
0.581a
Age (mean (SD))
47.31 (8.71)
42.10 (10.27)
0.008b
No studies
Primary studies
Secondary studies
Professional training
University studies
11.3
39.0
15.5
27.2
7.0
13.8
41.4
24.1
20.7
0
0.266c
a Chi square, b U-Mann Whitney, c H Kruskal Wallis
Time duration (months) (mean (SD))
106.6 (98.001)
59.6%, ≥ 8 years under pain
44,6
40,8
14,6
Neuropathic pain
Musculoskeletal pain
Fibromyalgia
Fig 2. Pain intensity and duration
Neuropathic pain (n=95)
Musculoskeletal pain (n=87)
Fibromyalgia (n=31)
pa
Anxiety (n=171)
49.3
47.1
71.4
0.078
Depression (n=178)
33.8
31.5
56.0
0.076
aChi square
38,5
19,7
41,8
86,2
3,4
10,3
0
20
40
60
80
100
120
No axiety (≤7)
Uncertain (8-10)
Anxiety (≥11)
53,5
16,4
30
93,1
6,9
0
0
20
40
60
80
100
120
No depression (≤7)
Uncertain (8-10)
Depression (≥11)
Cases
Controls
HAD Anxiety
HAD Depression
Fig 1. Pain types (N=213).
Variables
B (SE)
t
p-value
95% CI
Constant
25.636 (0.47)
54.54
<0.001
(24.71; 26.53)
Studies
No studies*
Primary education
Secondary education
Professional training
University studies
1.654 (0.48)
1.879 (0.57)
2.177 (0.50)
2.309 (0.69)
3.42
3.31
4.31
3.32
0.001
0.001
<0.001
0.001
(0.70; 2.61)
(0.76; 2.99)
(1.18; 3.17)
(0.94; 3.68)
Depression
No depression*
Uncertain
Depression
-0.580 (0.40)
-1.304 (0.33)
-1.45
-3.92
0.150
<0.001
(-1.37; 0.211)
(-1.96; -0.65)
Adjusted R2 = 0.178; df = 206
*Reference Category
Dependent variable: score on the MMSE
Table 1. Descriptive data.
Table 3. Variables associated to the cognitive status on chronic pain patients (N=213).
Fig 3. Frequency of depression and anxiety: Cases/Controls.
Table 2. Frequency of depression and anxiety: Pain Types.
Fig 4. Mean score of MMSE
3. Söderfjell, S., B. O. Molander, H. Johansson, M. Barnekow-Bergkvist & L. G. Nilsson (2006) Musculoskeletal pain complaints and performance on cognitive tasks over the adult life span. Scandinavian Journal of Psychology, 47, 349-359.
26,84
29,69
24
25
26
27
28
29
30
Cases (n=213)
Controls (n=29)
26,84
27
26,39
24
25
26
27
28
29
30
Neuropatic Pain (n=95)
Musculoskeletal Pain (n=87)
Fibromyalgia (n=31)