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Does chronic pain raise the risk of dementia, Alzheimer’s, or stroke?


Patients who reported experiencing widespread 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 sociodemographic circumstance.
Researchers analyzed data from 2,464 participants of the Framingham Offspring Study Cohort, who underwent examination by health practitioners between 1990 and 1994.

A study by scholars at Chongqing Medical University in China, which appears online in the journal Regional Anesthesia & Pain Medicine, found patients who reported widespread pain had an increased incidence of dementia and stroke.

Researchers Dr. Kanran Wang and Dr. Hong Liu found this increased risk to be independent of facets such as age, health, or sociodemographic factors.

The World Health Organization’s (WHO) 11th revision of the International Statistical Classification of Diseases and Related Health Problems defines widespread chronic pain as pain in at least four of five body regions. Widespread pain is a hallmark symptom of fibromyalgia.

Earlier studies found individuals who report experiencing widespread pain have an increased risk of a cardiovascular cause of death as well as an increased incidenceTrusted Source of cancer and reduced cancer survival. However, the researchers believe this is the first study to use a detailed review of medical records and autopsies to consider whether there is an association between widespread pain, dementia, and stroke.

Higher risk of dementia, stroke
For their study, the Chongqing Medical University researchers pulled data from the Framingham Heart Study (FHS). FHS is a large cohort study that started in 1948, with 5,209 white men and women between the ages of 30 and 62 years from the town of Framingham, Massachusetts. Originally, the purpose of the study was to understand heart disease better.

Now studying its third generation of participants, the FHS has encompassed more than 15,000 participants. For their work, the Chongqing Medical University researchers looked at about 2,464 participants of the Framingham Offspring Study Cohort. Health practitioners examined these participants between 1990 and 1994.

The participants also underwent laboratory tests and received a questionnaire to determine whether or not they experienced pain. Of the participants, 347 reported experiencing widespread pain.

The researchers found that these participants had:

a 43% higher risk for all-cause dementia
a 47% higher risk of Alzheimer’s disease
a 29% higher risk of stroke
The researchers presented three hypotheses for why individuals experiencing widespread pain might have an increased risk of developing dementia or having a stroke.

It could relate to lifestyle factors associated with experiencing chronic pain. For example, people who have chronic pain might not feel well enough to exercise regularly or shop for the groceries they need for a nutritious diet.

The researchers also theorize that widespread pain could directly compete for resources in the brain that handle cognitive processing. “The affective stress of [widespread pain] maybe, as other stressful exposures are, involved in quick cognitive decline via acknowledged cortisol-based pathways,” the study’s authors write.

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

However, the observational nature of the study prevents the researchers from establishing the underlying mechanisms behind the increase in risk. They also advise that with small numbers of stroke 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.

Linking pain and dementia, stroke risk
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 “a very first step in trying to understand whether there’s any relationship” between pain and increased risk for developing all types of dementia and having a stroke.

“I was actually excited to read this paper because I was hoping to see a really in-depth study looking at the different types of pain that might put people at more risk for dementia,” said Dr. Edelmayer, who completed her Ph.D. and postdoctoral training in medical pharmacology with a focus on neuropharmacology. “I think this paper brings up more questions actually than answers.”

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

The study’s real-world implications
Dr. Vernon Williams, founding director of the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, CA, told MNT he’s hopeful the results of the Chongqing Medical University study will shine a spotlight on the importance of treating pain.

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

A 2019 report found 83% of primary care doctors believe it is difficult to treat people with chronic pain because of the risks associated with opioid intake and the wider opioid crisis. Dr. Williams hopes this new study will remind health practitioners about the importance of managing pain.

“I think it also helps reinforce to other stakeholders — and that can be physical therapists, insurers, patients, and family members — about how important it is to be aware of widespread pain and to manage it effectively because not only does it improve function and performance and quality of life right now, it may also have an effect on cognitive function down the line,” Dr. Williams said.

13 ways to manage chronic pain

Chronic pain is complex, and it can take a person some time to find the best pain relief methods that work for them. There are many options to try, such as hot and cold therapy, yoga, or drug treatments.

Chronic pain may develop after an injury or due to a medical issue. Healthcare professionals define pain as chronic if it lasts longer than 3 monthsTrusted Source, or beyond the normal healing time for the underlying condition or injury.

Chronic pain can affect every part of a person’s life, from work and social life to sleep and mental health.

This article explores what pain management is, along with methods to ease pain and their effectiveness.

How common is chronic pain?

According to the Centers for Disease Control and Prevention (CDC), around 20% of adultsTrusted Source in the United States had chronic pain in 2016, while 8% had high-impact chronic pain.

The 2017 Global Burden of Disease StudyTrusted Source estimates that pain and diseases related to pain are the leading cause of disability worldwide, and the amount of people living with chronic pain is increasing.

Chronic pain has associations with numerous physical and mental health conditions, including:

sleep problems
social isolation
overuse of medication
What is pain management?
Pain management refers to techniques to reduce and control the amount of pain a person experiences over the long term.

There are many ways to manage pain, and not all of them include taking medication.

Physical techniques
Various physical methods can help relieve pain, including physical therapy, hot and cold therapy, massage, and acupuncture.

Hot and cold therapy
Hot and cold therapy is a common and safe technique to reduce pain.

Heat can help relax the muscles and dilate the blood vessels. It can also promote healing after an injury.

Cold therapy reduces blood flow and reduces inflammation that causes pain. It often involves applying an ice pack wrapped in a towel to the skin.

Massage is a type of soft-tissue manipulation. People may benefit from this technique when used with other pain management treatments, such as physical therapy and pain medication.

The benefits of massage include:

increased flexibility
reduced inflammation
improved posture
improved circulation
reduced stiffness
A 2007 reviewTrusted Source on massage found that it may be effective for lower back pain. However, there is mixed evidence from examining its benefits for other chronic pain types.

Physical therapy
Physical therapy involves physical techniques to strengthen and stretch the muscles and joints. It can relieve pain throughout the body, while the specific methods will vary by body part.

Therapeutic exercise can have long-term benefits for chronic pain, including helping people cope.

Techniques may involve massage, exercise plans, and red light therapy.

Acupuncture involves a practitioner applying thin needles to the skin at precise points in the body.

According to the National Center for Complementary and Integrative Health, evidence suggests this technique could help people manage certain pain conditions.

This includes short-term relief from pain in the lower back, neck, knee, and osteoarthritis. However, there is little evidence to suggest it is effective over the long term.

The proposed benefits of acupuncture are:

pain relief
reduced inflammation
reduced muscle spasms
Acupuncture is generally safe when performed by trained practitioners using sterile needles.

Mind-body techniques
Methods that combine psychology and the body can help many people manage chronic pain.

Cognitive behavior therapy
Psychological treatments for chronic pain include talking therapies, such as cognitive behavioral therapy (CBT).

Psychological treatments aim to reduce the negative impact that chronic pain can have on a person’s mental health.

A 2013 review on the effectiveness of psychological pain management techniques concludes that CBT is effective at reducing pain immediately after treatment compared with using no strategies.

The review also found that there was no evidence that CBT can reduce long-term pain. However, the technique was useful for reducing anxiety around pain and for improving quality of life.

Yoga aims to relax, strengthen, and keep the body flexible through stretching, with specific poses focusing on particular body areas.

A 2010 studyTrusted Source into yoga’s effects on chronic pain found that it did not decrease participants’ pain, but it did help them cope, and they were more in control of how their pain affected their everyday life.

However, other studiesTrusted Source have found yoga to be effective in reducing pain.

Yoga is a safe and accessible pain management technique that people can try at home, using online videos, or in a class with an instructor.

Tai chi
Tai chi is an exercise therapy involving slow, continuous, fluid body movements combined with breathing and relaxation techniques. The method is also gentle on the joints and muscles.

Tai chi can improve strength and joint stability, and the concentration it requires can improve a person’s mood.

According to a 2016 review,Trusted Source there is some evidence that the technique could help with chronic pain. It states that people using tai chi experienced improvements in chronic pain from rheumatoid arthritis, lower back pain, and osteoporosis.

Relaxation techniques
Dealing with chronic pain can be stressful for many reasons, such as not feeling in control regarding a person’s discomfort.

Relaxation techniques can help ease muscle tension, muscle spasms, aches, and pains. They can also release endorphins, which are the body’s natural painkillers.

A person can help reduce stress through relaxation, which can ease some of the burden of chronic pain while promoting better sleep.

Relaxation methods for chronic pain include:

Deep breathing techniques: Slow and relaxed breathing methods, such as box breathing, help relieve tension.
Progressive muscle relaxation: Involves tensing and relaxing each muscle group in turn, for 10 seconds each, from the head to the toes. Focus on breathing and avoid muscles that feel painful.
Thinking calmly: Spend 5 minutes imagining a calming scene, such as a sunny afternoon in nature, surrounded by green trees and birdsong.
Calming activities: Set aside time for relaxing activities such as having a warm bath, reading a book, or crafting.

Drug therapy
There is a wide range of medications to relieve pain. Each class and type of drug work differently, while some may be more suitable for certain people than others.

Nonsteroidal anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of medications that reduce inflammation and pain. They are available in capsules, tablets, or as creams or gels for the skin.

However, NSAIDs may causeTrusted Source issues with the stomach and the cardiovascular system in some people. Talk with a doctor before beginning treatment with NSAIDs.

Opioids can treat moderate-to-severe pain and are generally only appropriate for short periods, as they can be addictive.

CDC guidelinesTrusted Source recommend people should only use opioids when the benefits outweigh the risks.

There is a lack of evidence that this treatment works for chronic pain, as people typically use opioids for short periods.

Some antidepressants, such as amitriptyline, can help with pain relief.

Amitriptyline is an antidepressant that, at lower doses, people also use for chronic pain, such as diabetic neuropathy and fibromyalgia.

It can take 2–4 weeksTrusted Source for a person to feel the effects of the medication.

Side effects of amitriptyline can include:

dry mouth
Beta-blockers slow down the heart and stop hormones, such as adrenaline, from working. Some people use them to treat migraines.

A studyTrusted Source shows that beta-blockers at low doses can temporarily improve chronic pain in females with fibromyalgia and temporomandibular syndrome.

However, beta-blockers may not be suitable for everyone. Consult with a doctor before using them for chronic pain.

Medicinal cannabis and cannabidiol (CBD) are increasingly common pain treatments.

A 2017 reviewTrusted Source states that cannabis may ease neuropathic pain, but not pain due to fibromyalgia, headaches, or rheumatoid arthritis.

In addition, cannabis for medicinal purposes may not be legal everywhere. High doses can trigger side effects, so it is best to check with a health professional before using cannabis CBD for pain relief.

Read more about CBD for chronic pain here.

There are a variety of ways to manage chronic pain, while many are accessible and easy to use.

Most pain management techniques aim to reduce chronic pain or improve a person’s coping strategies.

Some pain management approaches, such as acupuncture, physical therapy, and yoga, are best performed with a professional therapist to ensure that a person can safely practice them.

People should speak with their doctor before beginning any new medication. This is to make sure they are safe, do not worsen pain, and will not interact with any other drugs a person is taking.