Study finds link to Alzheimer’s, dementia and stroke

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A new study suggests that chronic pain may increase the risk of all-cause dementia and Alzheimer’s disease. Eddie Pearson / Stocksy

Patients who reported general pain had an increased incidence of all-cause dementia, Alzheimer’s disease, and stroke.
This increased risk is independent of factors such as age, health or socio-demographic circumstances.
Researchers analyzed data from 2,464 participants in the Framingham Offspring Study Cohort, who were reviewed by health care practitioners between 1990 and 1994.

A study by academics at Chongqing Medical University in China, published online in the journal Regional anesthesia and pain medicine, found that patients who reported generalized pain had an increased incidence of dementia and stroke.

Researchers Dr Kanran Wang and Dr Hong Liu found that this increased risk was independent of factors such as age, health or socio-demographic factors.

The 11th revision of the World Health Organization (WHO) of the International statistical classification of diseases and related health problems defines chronic widespread pain in the form of pain in at least four of the five regions of the body. Generalized pain is a hallmark symptom of fibromyalgia.

Previous studies have found that people who report experiencing generalized pain have an increased risk of cardiovascular cause of death and a increased incidence cancer and reduced cancer survival. However, researchers believe this is the first study to use a detailed review of medical records and autopsies to determine if there is an association between generalized pain, dementia and stroke.

For their study, researchers at Chongqing Medical University extracted data from the Framingham Heart Study (FHS). FHS is a large cohort study that began in 1948, with 5,209 white men and women aged 30 to 62 from the city of Framingham, Massachusetts. Originally, the aim of the study was to gain a better understanding of heart disease.

Now entering its third generation of participants, the FHS has encompassed over 15,000 participants. For their work, researchers at Chongqing Medical University examined about 2,464 participants from the Framingham Offspring study cohort. Health practitioners examined these participants between 1990 and 1994.

The participants also underwent lab tests and were given a questionnaire to determine whether or not they felt pain. Of the participants, 347 reported experiencing generalized pain.

The researchers found that these participants had:

a 43% higher risk of all-cause dementia
a 47% higher risk of Alzheimer’s disease
29% higher risk of stroke

The researchers presented three hypotheses as to why people with generalized pain might have an increased risk of developing dementia or having a stroke.

This could be linked to lifestyle factors associated with chronic pain. For example, people with chronic pain may not feel well enough to exercise regularly or shop for the groceries they need for a nutritious diet.

The researchers also hypothesized that generalized pain could directly compete with the brain resources that handle cognitive processing. “The emotional stress of [widespread pain] perhaps, like other stressful exposures, are involved in rapid cognitive decline via recognized cortisol-based pathways, ”the study authors write.

Finally, the team hypothesized that generalized pain could be a preclinical phase of all-cause dementia and Alzheimer’s disease.

However, the observational nature of the study prevents researchers from establishing the mechanisms underlying the increased risk. They also indicate that with a small number of strokes and dementia, the relationship is likely to be multifactorial.

The authors also note that with the study sample being homogeneously white, the results may not be generalizable to people of other races or ethnicities.

In an interview with Medical News Today, Dr Rebecca Edelmayer, senior director of scientific engagement for the Alzheimer’s Association, called the Chongqing Medical University study “the very first step in trying to understand whether there is a relationship” between pain and an increased risk of developing all types of dementia and having a stroke.

“I was actually excited to read this article because I was hoping to see a really in-depth study on the different types of pain that might put people at increased risk for dementia,” said Dr. Edelmayer, who completed his study. doctorate. . and postgraduate training in medical pharmacology with a focus on neuropharmacology. “I think this article raises more questions than answers. “

Dr Edelmayer also pointed out that generalized pain is a broad category. She said MNT:

“The causes of pain are very different throughout the body. It can be cancer-induced pain, inflammatory pain – like arthritis, bone pain – like osteoarthritis, [and] neuropathic pain, which is a kind of abnormal signaling of pain and damaged nerves. There are so many different reasons people suffer.

Additionally, one type of pain may play a larger role in changing cognition than other types of pain, according to Edelmayer. “I think a lot more research is still needed,” she said.

Dr Vernon Williams, founding director of the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, California, said MNT He hopes the study results from Chongqing Medical University will highlight the importance of pain treatment.

“What this tells us is that, hopefully, as we improve pain management, we reduce the risk of cognitive dysfunction. We reduce the risk of strokes, ”said Dr Williams.

A 2019 report found 83% of primary care physicians believe it is difficult to treat people with chronic pain because of the risks associated with opioid use and the broader opioid crisis. Dr Williams hopes this new study will remind healthcare professionals of the importance of managing pain.

“I think it also helps to reinforce with other stakeholders – and this can be physiotherapists, insurers, patients and family members – how important it is to be aware of widespread pain and manage it effectively, because not only does it improve function and performance and quality of life right now, it can also have an effect on cognitive function in the long term, ”said Dr Williams.