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.”
Someone should really start paying attention to all the knees surgeries, particularly TKRs that don’t resolve chronic pain issues but actually make it worse. And then address the fact that once this issue is reported back to the surgeon, the patients is left to fend for themselves as the surgeon doesn’t want to hear that there are problems. They just want to cut on any unsuspecting poor soul that makes the mistake of letting them cut away. They don’t want to play detective once there is a problem. Need proof of this– go to facebook and look for groups concerning failed THRs and TKRs, metal implant allergies and sensitivities, chronic knee/ortho pain, knee replacements/failures, etc. And how many of the neurological disorders in seniors are actually caused by metal toxicities/allergies and NOT dementia or Parkinson’s? Reversible issues, not permanent life changing diseases? Thousands of HORROR stories of lives ruined. I’m sure my brain would light up like a Christmas tree. I feel like a rat has been gnawing unrelenting at my brain for years. Chronic knee pain that medication doesn’t touch and no orthopedists gives a DAMN about. And why should they? They made their cut. That’s the fun of it. That’s where the money’s at! After all, it’s NOT their problem. They don’t have to live with it. I wonder what the suicide rate is for chronic orthopedic pain patients, esp that made worse by a surgeon? Pain they now blame on themselves for making a poor decision, a regret for ever letting a surgeon touch them. Too bad no one cared when these patients were fighting to get their lives back and then finally just gave up! Too bad we can’t ask the dead.
Thank you for your message. Over the last few years, in part because of the opioid crisis, a lot of creative and smart people have come up with innovative pain reduction treatments. It’s a revolution in new ideas for reducing and managing chronic pain. We also published several articles about new products and techniques for pain management. You will also find on our website a video of a 2-hour course on innovative pain management that we organized in conjunction with Drexel University School of Medicine. Again, thank you for your message. What you are describing is a significant problem. But there is actually good news about the changing approach to treating and managing chronic pain. Robin Young, Editor and Publisher Orthopedics This Week.