Contact heat sensitivity and reports of unpleasantness in communicative people with mild to moderate cognitive impairment in Alzheimer’s disease: a cross-sectional study

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Background:
Compared to healthy controls, people with Alzheimer’s disease (AD) have been shown to receive less pain medication and report pain less frequently. It is unknown if these findings reflect less perceived pain in AD, an inability to recognize pain, or an inability to communicate pain.

Methods:
To further examine aspects of pain processing in AD, we conducted a cross-sectional study of sex-matched adults ≥65 years old with and without AD (AD: n = 40, female = 20, median age = 75; control: n = 40, female = 20, median age = 70) to compare the psychophysical response to contact-evoked perceptual heat thresholds of warmth, mild pain, and moderate pain, and self-reported unpleasantness for each percept.

Results:
When compared to controls, participants with AD required higher temperatures to report sensing warmth (Cohen’s d = 0.64, p = 0.002), mild pain (Cohen’s d = 0.51, p = 0.016), and moderate pain (Cohen’s d = 0.45, p = 0.043). Conversely, there were no significant between-group differences in unpleasantness ratings (p > 0.05).

Conclusions:
The between-group findings demonstrate that when compared to controls, people with AD are less sensitive to the detection of thermal pain but do not differ in affective response to the unpleasant aspects of thermal pain. These findings suggest that people with AD may experience greater levels of pain and potentially greater levels of tissue or organ damage prior to identifying and reporting injury. This finding may help to explain the decreased frequency of pain reports and consequently a lower administration of analgesics in AD.

Keywords:
Pain, Dementia, Alzheimer’s disease, Unpleasantness, Psychophysics

Autoři: Todd B. Monroe ^1*; Stephen J. Gibson ²; Stephen P. Bruehl ³; John C. Gore ⁴; Mary S. Dietrich ⁵; Paul Newhouse ⁶; Sebastian Atalla ¹; Ronald L. Cowan ⁷
Působiště autorů: Vanderbilt University School of Nursing, Vanderbilt University Institute of Imaging Science, Vanderbilt Psychiatric Neuroimaging Program, Nashville, Tennessee, USA. ¹; National Ageing Research Institute, Royal Melbourne Hospital, PO Box 212 , Melbourne, VIC 0 0, Australia. ²; Vanderbilt University School of Medicine, Nashville, Tennessee, USA. ³; Vanderbilt University Institute of Imaging Science, Nashville, Tennessee, USA. ⁴; Vanderbilt Psychiatric Neuroimaging Program, Vanderbilt University Schools of Medicine and Nursing, Nashville, Tennessee, USA. ⁵; Vanderbilt Center for Cognitive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA ⁶; Vanderbilt Psychiatric Neuroimaging Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. ⁷
Vyšlo v časopise: BMC Medicine 2016, 14:74
Kategorie: Research article
prolekare.web.journal.doi_sk: https://doi.org/10.1186/s12916-016-0619-1

© 2016 Monroe et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
The electronic version of this article is the complete one and can be found online at: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0619-1

Souhrn

Keywords:
Pain, Dementia, Alzheimer’s disease, Unpleasantness, Psychophysics

Zdroje

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