Chronic Pain May Contribute to Structural Brain Change

Patients might now have an additional reason to address musculoskeletal pain. New work from the University of Florida (UF) has found a link between chronic knee pain and key demographic factors and differences in regions of the brain associated with memory.

The study, “Relationships Between Chronic Pain Stage, Cognition, Temporal Lobe Cortex, and Sociodemographic Variables,” appears in the April 20. 2021 edition of the Journal of Alzheimer’s Disease.

“Arthritis is a highly prevalent chronic musculoskeletal pain condition, with the knee as the most commonly affected joint,” said co-author Kimberly Sibille, Ph.D., M.A., associate professor of aging and geriatric research and pain medicine in the UF College of Medicine, to OTW.

“Arthritis affects more than 1 in 3 adults in the U.S. with more than half of older adults affected. Knee pain is becoming more common and is increasing with the aging U.S. population. Knee pain reduces quality of life by reducing mobility,” added co-author Jared Tanner, Ph.D., research assistant professor of clinical and health psychology in the UF College of Public Health and Health Professions.

The researchers looked at 147 non-Hispanic Black and non-Hispanic white adults without dementia who had or were at risk of having knee osteoarthritis (OA).

The authors wrote, “There were ethnic/race group differences in the Montreal Cognitive Assessment scores but no relationship with chronic knee pain stage. Ethnicity/race moderated the relationship between Alzheimer’s disease-related temporal lobe thickness and chronic pain stage with quadratic patterns suggesting thinner cortex in high chronic pain stage non-Hispanic Black adults.”

Hari Parvataneni, M.D. division chief of Adult Arthroplasty and Joint Reconstruction, Joint Replacement at the UF College of Medicine explained further, the effects and nuances of chronic pain on patients (Dr. Parvataneni was not involved with the study) to OTW, “Pain has traditionally been treated as a peripheral issue, typically with focus on a body part. For many patients with chronic pain, it is becoming clear there are systemic effects and associations.”

“Through novel multidisciplinary research such as this, we are understanding that chronic pain can cause central sensitization which can even be identified by imaging. This worsens chronic pain, cause multifocal pain, and often reduces the effects of pain relief therapies and surgeries.”

“Additionally, chronic pain can have systemic effects (or compound diseases) such as depression and even affect immune modulation. Now this study finds a multifactorial association between chronic pain and structural brain differences. This research group has previously demonstrated cognitive changes associated with major surgical interventions (see UF PeCAN).”

“The authors should be congratulated for this very innovative work which is important to a broad population of patients and many medical specialties. This furthers our understanding of the complex effects and systemic scope of chronic pain and further underscores the importance of multidisciplinary research such as this. It also makes more urgent, the need for integrated multidisciplinary care of patients with chronic pain.”

Addressing the preoperative angle was co-author Catherine Price, Ph.D., A.B.P.P., associate professor of clinical and health psychology, UF College of Public Health and Health Professions, who told OTW, “This study is important as it highlights the relevance of life experiences and pain on the brain.”

“As our population grows older and seeks more surgeries for knee pain, it is imperative perioperative clinicians understand these brain-behavioral relationships; our team and others show that preoperative brain integrity, cognitive, and mood function predict acute postoperative brain changes, risk for delirium, and long-term cognitive change. It is time we pay attention to preoperative brain health from a life experiences standpoint in order to promote individualized perioperative care.”