Research, guidelines, and experts in the field suggest that persons with cognitive impairment report pain less often and at a lower intensity than those without cognitive impairment. However, this presupposition is derived from research with important limitations, namely, inadequate power and lack of multivariate adjustment.
We conducted a cross-sectional analysis of the Canadian Study of Health and Aging to evaluate the relationship between cognitive status and pain self-report.
Cognitive status was assessed using the Modified Mini-Mental State Examination. Pain was assessed using a 5-point verbal descriptor scale. For analysis, responses were dichotomized into "no pain" vs. "any pain" and "pain at a moderate or higher intensity" vs. "pain not at a moderate or higher intensity." Additional predictors included demographics, physical function, depression, and comorbidity.
Of 5,703 eligible participants, 306 (5.4%) did not meet inclusion criteria, leaving a total of 5,397, of whom 876 (16.2%) were cognitively impaired. In the unadjusted analysis, significantly more cognitively intact (n=2,541; 56.2%) than cognitively impaired (n=456; 52.1%; P=0.03) participants reported noncancer pain. There was no significant difference in the proportion of cognitively intact (n=1,623; 35.9%) and impaired (n=329; 37.6%; P=0.36) participants who reported pain to be at moderate or higher intensity. In multivariate analyses, cognitively impaired participants did not have lower odds of reporting any noncancer pain (odds ratio [OR]=0.83 [0.68-1.01]; P=0.07) or pain at a moderate or higher intensity (OR=0.95 [0.78-1.16]; P=0.62).
Non-cancer pain was equally prevalent in people with and without cognitive impairment, which contrasts with the currently held opinion that cognitively impaired persons report noncancer pain less often and at a lower intensity.
Cites: Lancet. 1999 Oct 9;354(9186):1248-5210520633
Cites: Med Care. 1991 Feb;29(2):169-761994148
Cites: J Gerontol A Biol Sci Med Sci. 2005 Apr;60(4):524-915933396
Cites: Brain. 2006 Nov;129(Pt 11):2957-6516951408
Cites: Psychiatry. 1999 Fall;62(3):265-7210612117
Cites: J Am Geriatr Soc. 2000 Dec;48(12):1607-1111129750
Cites: Pain. 2001 May;92(1-2):173-8611323138
Cites: Rheumatol Int. 2001 Apr;20(3):85-711354562
Cites: Disabil Rehabil. 2001 Oct 15;23(15):654-6411720115
Cites: Int Psychogeriatr. 2001;13 Supp 1:7-1811892976
Cites: Fam Pract. 2002 Oct;19(5):471-512356697
Cites: J Gerontol A Biol Sci Med Sci. 2003 Jan;58(1):76-8112560416