The Vicious Cycle of Chronic Pain in Aging Requires Multidisciplinary Non-pharmacological Approach to Treatment

Social Contact Frequency and Pain among Older Adults with HIV: An Ecological Momentary Assessment Study

BACKGROUND

Social relationships are important for pain management among individuals with HIV, but the impact of daily social contact on pain responses in real-time, real-world settings has never been specifically examined.

PURPOSE

The purpose of the present study was to examine the relationship between social contact frequency and pain, and the role of negative and positive affect in this relationship among older adults with HIV using ecological momentary assessment (EMA).

METHODS

A total of 66 (Mage = 59.3, SD = 6.3, range: 50-74) older adults with HIV completed EMA surveys that included social contact frequency, pain level, and negative and positive affect four times per day for 2 weeks. Mixed-effects regression models were used to examine concurrent and lagged associations between social contact frequency, pain, and negative and positive affect.

RESULTS

Greater recent social contact frequency was associated with less severe current pain (unstandardized B = -0.04, 95% CI: -0.08, -0.01, p = .014), while greater current pain was associated with lower subsequent social contact frequency (unstandardized B = -0.07, 95% CI: -0.11, -0.03, p < .001). Further, higher current negative affect was related to greater current pain, and this relationship was dampened by increased recent social contact frequency (unstandardized B = -0.17, 95% CI: -0.26, -0.08, p < .001). Neither negative nor positive affect was significantly associated with the relationship between current pain and subsequent social contact frequency.

CONCLUSIONS

Social contact frequency and pain are bidirectionally and inversely associated among older adults with HIV. Further, recent social contact influences current pain by attenuating negative affect. Together, these results highlight the need to address social engagement in interventions for pain among older adults with HIV.

The Potential Contribution of Chronic Pain and Common Chronic Pain Conditions to Subsequent Cognitive Decline, New Onset Cognitive Impairment, and Incident Dementia: A Systematic Review and Conceptual Model for Future Research

BACKGROUND

Growing evidence suggests that chronic pain and certain chronic pain conditions may increase risk for cognitive decline and dementia.

OBJECTIVE

In this systematic review, we critically evaluate available evidence regarding the association of chronic pain and specific common chronic pain conditions to subsequent decline in cognitive function, new onset cognitive impairment (CI), and incident Alzheimer's disease and related dementias (ADRD); outline major gaps in the literature; and provide a preliminary conceptual model illustrating potential pathways linking pain to cognitive change.

METHODS

To identify qualifying studies, we searched seven scientific databases and scanned bibliographies of identified articles and relevant review papers. Sixteen studies met our inclusion criteria (2 matched case-control, 10 retrospective cohort, 2 prospective cohort), including 11 regarding the association of osteoarthritis (N = 4), fibromyalgia (N = 1), or headache/migraine (N = 6) to incident ADRD (N = 10) and/or its subtypes (N = 6), and 5 investigating the relation of chronic pain symptoms to subsequent cognitive decline (N = 2), CI (N = 1), and/or ADRD (N = 3).

RESULTS

Studies yielded consistent evidence for a positive association of osteoarthritis and migraines/headaches to incident ADRD; however, findings regarding dementia subtypes were mixed. Emerging evidence also suggests chronic pain symptoms may accelerate cognitive decline and increase risk for memory impairment and ADRD, although findings and measures varied considerably across studies.

CONCLUSION

While existing studies support a link between chronic pain and ADRD risk, conclusions are limited by substantial study heterogeneity, limited investigation of certain pain conditions, and methodological and other concerns characterizing most investigations to date. Additional rigorous, long-term prospective studies are needed to elucidate the effects of chronic pain and specific chronic pain conditions on cognitive decline and conversion to ADRD, and to clarify the influence of potential confounding and mediating factors.

Effects of Mantra Meditation versus Music Listening on Knee Pain, Function, and Related Outcomes in Older Adults with Knee Osteoarthritis: An Exploratory Randomized Clinical Trial (RCT)

OBJECTIVE

Disease-modifying treatments for OA remain elusive, and commonly used medications can have serious side effects. Although meditation and music listening (ML) have been shown to improve outcomes in certain chronic pain populations, research in OA is sparse. In this pilot RCT, we explore the effects of two mind-body practices, mantra meditation (MM) and ML, on knee pain, function, and related outcomes in adults with knee OA.

METHODS

Twenty-two older ambulatory adults diagnosed with knee OA were randomized to a MM (N=11) or ML program (N=11) and asked to practice 15-20 minutes, twice daily for 8 weeks. Core outcomes included knee pain (Knee Injury and Osteoarthritis Outcome Score [KOOS] and Numeric Rating Scale), knee function (KOOS), and perceived OA severity (Patient Global Assessment). Additional outcomes included perceived stress (Perceived Stress Scale), mood (Profile of Mood States), sleep (Pittsburgh Sleep Quality Index), and health-related quality of life (QOL, SF-36). Participants were assessed at baseline and following completion of the program.

RESULTS

Twenty participants (91%) completed the study (9 MM, 11 ML). Compliance was excellent; participants completed an average of 12.1±0.83 sessions/week. Relative to baseline, participants in both groups demonstrated improvement post-intervention in all core outcomes, including knee pain, function, and perceived OA severity, as well as improvement in mood, perceived stress, and QOL (Physical Health) (p's≤0.05). Relative to ML, the MM group showed greater improvements in overall mood and sleep (p's≤0.04), QOL-Mental Health (p<0.07), kinesiophobia (p=0.09), and two domains of the KOOS (p's<0.09).

CONCLUSIONS

Findings of this exploratory RCT suggest that a simple MM and, possibly, ML program may be effective in reducing knee pain and dysfunction, decreasing stress, and improving mood, sleep, and QOL in adults with knee OA.