Friday, January 7, 2011

Chronic Back Pain Affects Memory, Concentration

Briefly NotedAlmost all persons (80%) experience lower back (lumbosacral) pain at some time in their lives, and consequences for the 10% to 20% in whom this condition becomes chronic can extend beyond the pain itself. Recent research observes that people living with persistent spinal pain experience difficulties with mental concentration and remembering information.

In the study, described in a report appearing in the January 2011 edition of Neuroscience and Behavioral Physiology, Russian researchers divided 64 patients with musculoskeletal pain syndromes in the lumbosacral area persisting for more than 3 months into 2 age groups: 30-50 years (n=41) and 51-60 years (n=23). A reference control group consisted of 20 healthy volunteers comparable in terms of gender, age, and level of education. All subjects underwent clinical neurological, orthopedic, and psychological evaluations.

In patients with chronic spinal pain, complaints of difficulty with mental concentration were present in roughly 17%, and 1-in-5 (20.2%) had problems with remembering information. Also, compared with healthy subjects, patients with chronic pain in both age groups had significantly worse performance in tests assessing attention, mental flexibility, and in visuomotor coordination (for example, reduced ability to control the direction of hand movement while tracing the changing path of a printed line, as found in patients with Parkinson’s disease).

Cognitive dysfunctions in younger patients were worsened by pain intensity and negative emotional characteristics of pain, particularly anxiety. In older patients cognitive deficits were influenced by anxiety and emotional distress, and by their level of catastrophizing; that is, harboring irrational thoughts and excessive fears about the severity of their condition.

COMMENTARY: In our ongoing series on “Pain and the Great Brain Robbery!” [eg, here] we have discussed how chronic or intractable pain can detrimentally affect brain function and structure, particularly in limbic areas influencing emotions and cortical regions affecting cognitive, or thought, processes. This newly reported research reinforces the notion that, over time, persistent pain may have serious repercussions in terms of mental functioning.

The researchers conclude that mind-related treatments — including psychotherapy and psychiatric medications (eg, antidepressants, sedatives) — might be helpful for relieving the cognitive dysfunctions associated with chronic spinal pain. Other research has suggested that opioid therapy, at adequate dosing, may confer psychotherapeutic benefits beyond their role as effective analgesics and this seems worthy of further exploration [discussed in blogpost here]. Most important may be aggressively treating acute pain before it becomes chronic, or at least earlier rather than later in the course of persistent pain.

REFERENCE: Melkumova KA, Podchufarova EV, Yakhno NN. Characteristics of Cognitive Functions in Patients with Chronic Spinal Pain. Neurosci Behav Physiol. 2011;41(1):42-46 [abstract here].