Pain worsens cognition

The following article was in Medscape News.  I agree with the basic premise, although fibromyalgia is a unique pain problem.  The cognitive deficits with fibromyalgia can be explained by alternative knowledge through homeopathy, but I will accept anything in print that shows that people in pain are possibly more dangerous on the highway than people appropriately treated with medication.  We need to stop the charges of DUI just because someone is on pain medication.  The side effects (except constipation) of opiates wear off in about a month and a person is functioning normally.

From Medscape Medical News

Pain Negatively Affects Cognition in Fibromyalgia

February 6, 2012 (Miami Beach, Florida) — Pain is the primary factor contributing to cognitive impairment in patients with fibromyalgia syndrome, over and above depression, anxiety, fatigue, sleep complaints, and medication use, reported Stefan Duschek, PhD, from the University of Munich, in Germany, here at the 6th World Congress of the World Institute of Pain.

Patients with fibromyalgia scored worse than healthy control subjects on mathematical thinking and attentional control. “A large part of the variance on these tests was explained by pain,” said Dr. Duschek in an interview with Medscape Medical News. “The most important factor underlying these deficits is pain, nothing else; it’s not depression, it’s not anxiety, but pain.”

The findings corroborate the presence of substantive cognitive impairment in patients with fibromyalgia, although the debate remains open, said Dr. Duschek.

This study “adds evidence to the suggestion that the most important factor is pain. There are interactions between pain, anxiety, depression, and cognitive function…but the most important factor seems to be pain.”

The researchers compared 35 patients with fibromyalgia and 29 healthy control subjects. All participants completed the Uchida-Kraepelin test, a neuropsychologic instrument that quantifies numerical ability, attentional control, and speed of cognitive processing. Performance is measured in 5 separate 1-minute intervals to evaluate improvement in performance over time.

Possible predictors of cognitive function were measured, including pain (using the McGill Pain Inventory), depression (using the Beck Depression Inventory), anxiety (using the State–Trait Anxiety Inventory), fatigue and sleep (using the Fatigue Severity Scale and the Oviedo Sleep Questionnaire), and medication intake, including antidepressants, antianxiolytics, and opiate and nonopiate pain medication.

During each of the 5 task periods, the number of calculations performed was lower in the fibromyalgia group than in the control group (P < .01), and improvement in performance over time was less pronounced (P < .05).

Of interest, patients taking opiate medication performed better than those who were not (P < .05). “Our hypothesis was the opposite — that opiates disrupt cognitive function — but it makes sense; it reduces pain intensity so people can concentrate better,” said Dr. Duschek.

In fact, higher pain ratings predicted lower cognitive performance (P < .05), whereas depression, anxiety, fatigue, and sleep complaints were unrelated, he said.

“Pain is an attention-demanding condition; one may suppose that central nociceptive activity detracts from cognition by requiring enhanced neural processing resources.”

The research was supported by a grant from the Spanish Ministry of Science and Innovation and cofinanced by Fonds Européen de Développement Régional (FEDER Proyect PSI2009-09812). Dr. Duschek has disclosed no relevant financial relationships.

6th World Congress of the World Institute of Pain: Abstract 112. Presented February 4, 2012.


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