History of chronic pain and opioid use is associated with cognitive decline and mild cognitive impairment.

IF 2.6 4区心理学 Q2 CLINICAL NEUROLOGY

Journal of the International Neuropsychological Society Pub Date : 2025-07-14 DOI:10.1017/S1355617725101057

Tyler R Bell, Jeremy A Elman, Daniel E Gustavson, Michael J Lyons, Christine Fennema-Notestine, McKenna E Williams, Matthew S Panizzon, Rahul C Pearce, Chandra A Reynolds, Mark Sanderson-Cimino, Rosemary Toomey, Amy Jak, Carol E Franz, William S Kremen

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引用次数: 0

Abstract

Background: The impact of chronic pain and opioid use on cognitive decline and mild cognitive impairment (MCI) is unclear. We investigated these associations in early older adulthood, considering different definitions of chronic pain.

Methods: Men in the Vietnam Era Twin Study of Aging (VETSA; n = 1,042) underwent cognitive testing and medical history interviews at average ages 56, 62, and 68. Chronic pain was defined using pain intensity and interference ratings from the SF-36 over 2 or 3 waves (categorized as mild versus moderate-to-severe). Opioid use was determined by self-reported medication use. Amnestic and non-amnestic MCI were assessed using the Jak-Bondi approach. Mixed models and Cox proportional hazards models were used to assess associations of pain and opioid use with cognitive decline and risk for MCI.

Results: Moderate-to-severe, but not mild, chronic pain intensity (β = -.10) and interference (β = -.23) were associated with greater declines in executive function. Moderate-to-severe chronic pain intensity (HR = 1.75) and interference (HR = 3.31) were associated with a higher risk of non-amnestic MCI. Opioid use was associated with a faster decline in verbal fluency (β = -.18) and a higher risk of amnestic MCI (HR = 1.99). There were no significant interactions between chronic pain and opioid use on cognitive decline or MCI risk (all p-values > .05).

Discussion: Moderate-to-severe chronic pain intensity and interference related to executive function decline and greater risk of non-amnestic MCI; while opioid use related to verbal fluency decline and greater risk of amnestic MCI. Lowering chronic pain severity while reducing opioid exposure may help clinicians mitigate later cognitive decline and dementia risk.

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慢性疼痛和阿片类药物使用史与认知能力下降和轻度认知障碍有关。

背景：慢性疼痛和阿片类药物使用对认知能力下降和轻度认知障碍（MCI）的影响尚不清楚。考虑到慢性疼痛的不同定义，我们在老年早期研究了这些关联。方法：越南时期男性双胞胎衰老研究（VETSA）；N = 1042)接受了认知测试和病史访谈，平均年龄分别为56岁、62岁和68岁。慢性疼痛的定义采用疼痛强度和SF-36在2或3波中的干扰评分（分为轻度和中度至重度）。阿片类药物的使用由自我报告的药物使用来确定。使用Jak-Bondi方法评估遗忘型和非遗忘型轻度认知障碍。使用混合模型和Cox比例风险模型来评估疼痛和阿片类药物使用与认知能力下降和MCI风险的关系。结果：中度至重度慢性疼痛强度（β = - 0.10）和干扰（β = - 0.23）与执行功能的更大下降相关。中度至重度慢性疼痛强度（HR = 1.75）和干扰（HR = 3.31）与非遗忘型轻度认知损伤的高风险相关。阿片类药物的使用与语言流畅性的快速下降（β = - 0.18）和遗忘性MCI的高风险（HR = 1.99）相关。慢性疼痛和阿片类药物使用对认知能力下降或MCI风险没有显著的相互作用（p值均为0.05）。讨论：中重度慢性疼痛强度和干扰与执行功能下降和非遗忘型轻度认知损伤的高风险相关；而阿片类药物的使用与语言流畅性下降和遗忘性轻度认知障碍的风险增加有关。降低慢性疼痛的严重程度，同时减少阿片类药物的暴露，可能有助于临床医生减轻后来的认知能力下降和痴呆的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the International Neuropsychological Society 医学-精神病学

CiteScore

5.40

自引率

3.80%

发文量

185

审稿时长

4-8 weeks

期刊介绍： The Journal of the International Neuropsychological Society is the official journal of the International Neuropsychological Society, an organization of over 4,500 international members from a variety of disciplines. The Journal of the International Neuropsychological Society welcomes original, creative, high quality research papers covering all areas of neuropsychology. The focus of articles may be primarily experimental, applied, or clinical. Contributions will broadly reflect the interest of all areas of neuropsychology, including but not limited to: development of cognitive processes, brain-behavior relationships, adult and pediatric neuropsychology, neurobehavioral syndromes (such as aphasia or apraxia), and the interfaces of neuropsychology with related areas such as behavioral neurology, neuropsychiatry, genetics, and cognitive neuroscience. Papers that utilize behavioral, neuroimaging, and electrophysiological measures are appropriate. To assure maximum flexibility and to promote diverse mechanisms of scholarly communication, the following formats are available in addition to a Regular Research Article: Brief Communication is a shorter research article; Rapid Communication is intended for "fast breaking" new work that does not yet justify a full length article and is placed on a fast review track; Case Report is a theoretically important and unique case study; Critical Review and Short Review are thoughtful considerations of topics of importance to neuropsychology and include meta-analyses; Dialogue provides a forum for publishing two distinct positions on controversial issues in a point-counterpoint format; Special Issue and Special Section consist of several articles linked thematically; Letter to the Editor responds to recent articles published in the Journal of the International Neuropsychological Society; and Book Review, which is considered but is no longer solicited.