Chronic Pain In Later Life Research Articles

Current Evidence for Biological Biomarkers and Mechanisms Underlying Acute to Chronic Pain Transition across the Pediatric Age Spectrum.

Chronic pain is highly prevalent in the pediatric population. Many factors are involved in the transition from acute to chronic pain. Currently, there are conceptual models proposed, but they lack a mechanistically sound integrated theory considering the stages of child development. Objective biomarkers are critically needed for the diagnosis, risk stratification, and prognosis of the pathological stages of pain chronification. In this article, we summarize the current evidence on mechanisms and biomarkers of acute to chronic pain transitions in infants and children through the developmental lens. The goal is to identify gaps and outline future directions for basic and clinical research toward a developmentally informed theory of pain chronification in the pediatric population. At the outset, the importance of objective biomarkers for chronification of pain in children is outlined, followed by a summary of the current evidence on the mechanisms of acute to chronic pain transition in adults, in order to contrast with the developmental mechanisms of pain chronification in the pediatric population. Evidence is presented to show that chronic pain may have its origin from insults early in life, which prime the child for the development of chronic pain in later life. Furthermore, available genetic, epigenetic, psychophysical, electrophysiological, neuroimaging, neuroimmune, and sex mechanisms are described in infants and older children. In conclusion, future directions are discussed with a focus on research gaps, translational and clinical implications. Utilization of developmental mechanisms framework to inform clinical decision-making and strategies for prevention and management of acute to chronic pain transitions in children, is highlighted.

Regional vs global physical therapy interventions to treat chronic pain in survivors of trauma: a randomized controlled trial

ABSTRACT Background A history of traumatic life events is associated with chronic pain in later life. Physical therapists utilize a variety of methods to treat pain, however, they have struggled to find effective interventions to improve patient outcomes. Objective To compare impairment-based, regional (REGION-PT) physical therapy (PT) to a global (GLOBAL-PT) model consisting of pain neuroscience education, graded motor imagery, and exercise for adults with chronic pain and history of trauma. Design Randomized Controlled Trial. Methods Adults ≥ 18 years of age with chronic pain and a history of ≥1 trauma identified through the Life Events Checklist received the allocated intervention once a week for six weeks. Treatment effects were assessed using linear mixed models. Results Ninety-eight participants completed the trial. There were no difference in outcomes between groups. There were significant interactions between race and intervention. Both interventions were associated with improvements in pain interference for white participants, but non-white participants experienced improvement only with GLOBAL-PT. Regardless of allocation, participants improved in physical function, six of the PROMIS-29 domains, and in pain interference measures. Conclusion Both interventions are reasonable strategies for individuals with chronic pain and a history of trauma.

Communication About Chronic Pain in Older Persons' Social Networks: Study Protocol of a Qualitative Approach.

A lack of social relations appears to impact on health and life expectancy among the older persons. The quality and diversity of social relations are correlated with good health and well-being in later life. Chronic pain is a crucial issue in aging population. Effective communication between the older persons with chronic pain, their relatives and the actors of the healthcare system facilitates the management of this condition. Studies on communication in later life generally do not consider the older persons' social network as a whole, focusing only a specific segment (e.g., family or medical staff). This lack of scientific data prevents the actors of the healthcare system from offering solutions to bridge clinically relevant communication gaps. As a consequence, our study has three objectives: (1) to identify how the older persons perceive communication about chronic pain with their social network; (2) to identify their unmet communication needs; (3) to develop recommendations that improve communication about chronic pain in later life. The study will be divided into two phases. The first phase will meet objectives 1 and 2. It will involve individual interviews with about 50 people over 75 years old suffering from chronic pain and without major cognitive or auditory troubles. In this phase, we will apply a multi-layered analysis. We will map the older persons' personal network and identify their communication practices and needs, by combining content and discourse analysis with social network theories. The second phase of the study will aim at recommendations based on the results of the first phase (objective 3). It will require focus groups with different sets of stakeholders (older persons, relative caregivers, health professionals, decision-makers). In the second phase, we will use content analysis to pinpoint the concerns and suggestions for action. The results will be disseminated on three levels: (1) to the scientific world (specialists in the field of health and aging and health communication); (2) to health practitioners working with older persons; (3) to society at large, with a focus on institutions and groups directly concerned by the issue.

Moderate to Severe Chronic Pain in Later Life: Risk and Resilience Factors for Recovery

Despite extensive research on the development and risk factors of chronic pain, the process of recovery from chronic pain in later life has been rarely studied. We estimated the recovery rate of moderate to severe chronic pain (chronic pain of moderate or severe severity or interfering with usual activities) among older adults and investigated predictors of recovery. Leveraging the longitudinal Health and Retirement Study 2006–2016 data (6 waves), we estimated the biennial national attrition-adjusted recovery rate of moderate to severe chronic pain among 6,132 US adults aged 65–75 at baseline. Generalized estimating equation Poisson models examined pain-related, sociodemographic, psychosocial and health-related factors in relation to recovery within any 2-year interval using longitudinal lagged design. Between 2006–2016, the prevalence of moderate to severe chronic pain increased from 28% to 33% with the incidence increasing from 14% to 18% and the recovery rate approximately 30%. Previous chronic pain duration, age, chronic diseases and a personality trait (agreeableness) were associated with a lower probability of recovery. Greater financial wealth and physical activity, better sleep quality and self-reported health were associated with a greater probability of recovery. Interventions that improve physical activity and sleep quality may be important avenues for reducing chronic pain burden among older adults. PerspectiveOur longitudinal findings suggested that recovery from moderate to severe chronic pain is common in later life and we further identified several key factors associated with this recovery process. Future research should consider the potential of interventions that improve physical activity and sleep quality to enhance recovery among older adults.

New Evidence on the Biobehavioral Mechanisms of Chronic Pain in Aging African Americans

African American older adults are living longer with chronic pain, which presents a huge personal and societal burden. A growing group of scholars are now devoted to accurately and precisely characterizing and phenotyping the experience of pain in aging using within-group and advanced methodological designs to elucidate the biopsychosocial-behavioral responses to pain. In this symposium, five dynamic presenters present new evidence on mechanisms of pain in older African-Americans. Dr. Roach’s investigation reveals the effect of genetic alterations of sickle cell disease (SCD) on stress-related pain in younger and older adults; this scientific inquiry is especially important because there is little research on SCD in aging. Next, Dr. Terry, extends these findings by exploring the association between psychosocial factors such as experiences of discrimination, pain catastrophizing, and perceived stress on neural (brain) responses via magnetic resonance imaging. From a clinical perspective, Dr. Booker reports on the first-ever model of intra-racial differences in movement-evoked pain in older African-Americans with knee osteoarthritis and healthy controls. Our final two presenters use a translational approach to identify how older African-Americans cope with chronic pain. Dr. Robinson-Lane’s study highlights the unique experience and predictors of coping, adaptation, and self-management of chronic pain in Black dementia caregivers. Finally, Dr. Cobb’s research from a large cross-sectional study correlates social, behavioral, and health factors with opioid and psychotropic use in economically disadvantaged older African-Americans. This symposium offers novel ways of understanding social determinants of pain and assisting African-Americans and their caregivers to manage complex chronic pain in later life.

Does epigenetic 'memory' of early-life stress predispose to chronic pain in later life? A potential role for the stress regulator FKBP5.

Animal behaviours are affected not only by inherited genes but also by environmental experiences. For example, in both rats and humans, stressful early-life events such as being reared by an inattentive mother can leave a lasting trace and affect later stress response in adult life. This is owing to a chemical trace left on the chromatin attributed to so-called epigenetic mechanisms. Such an epigenetic trace often has consequences, sometimes long-lasting, on the functioning of our genes, thereby allowing individuals to rapidly adapt to a new environment. One gene under such epigenetic control is FKBP5, the gene that encodes the protein FKPB51, a crucial regulator of the stress axis and a significant driver of chronic pain states. In this article, we will discuss the possibility that exposure to stress could drive the susceptibly to chronic pain via epigenetic modifications of genes within the stress axis such as FKBP5. The possibility that such modifications, and therefore, the susceptibility to chronic pain, could be transmitted across generations in mammals and whether such mechanisms may be evolutionarily conserved across phyla will also be debated. This article is part of the Theo Murphy meeting issue 'Evolution of mechanisms and behaviour important for pain'.

It Was Not Safe to Feel Angry: Disrupted Early Attachment and the Development of Chronic Pain in Later Life

Using detailed clinical material from her treatment of three patients referred by physiatrist John E. Sarno, for psychological treatment of chronic pain, Dr Anderson illustrates a relationship between dissociated/repressed affect and the development of chronic musculoskeletal back pain. Sarno, conversant with the fundamentals of psychoanalysis, theorised that the somatic pain, which he termed tension myoneural syndrome (TMS), served as a distraction from emotions that were unbearable. That is, the pain served as a psychological defense or survival tactic. In treatment, the adverse impact of overwhelming physical and emotional experiences on attachment and emotion regulation are identified and discussed. Detailed clinical process, which includes the use of trauma treatment techniques, illuminate how psychological treatment can be used to help patients identify and tolerate feelings associated with early life stress, leading to relief from the somatic pain. Anderson, informed by the psychosomatic theories of Krystal and McDougall and by contemporary attachment theorists, advances the position that the physician as diagnostician functions symbolically as the "parent" who links mind and body, thereby reducing the patient's fear of pain and creating a secure attachment bond. In this secure attachment relationship, the physician "authorises" the patient to experience emotions that were previously disavowed. In the relationship with an empathic relational psychoanalyst, the patient's pain resolves as s/he builds a capacity to identify and tolerate emotions and learns how to use emotions, particularly anger, to enhance relationships and improve their quality of life.

Microglia in health and pain: impact of noxious early life events.

What is the topic of this review? This review discusses the origins and development of microglia, and how stress, pain or inflammation in early life disturbs microglial function during critical developmental periods, leading to altered pain sensitivity and/or increased risk of chronic pain in later life. What advances does it highlight? We highlight recent advances in understanding how disrupted microglial function impacts the developing nervous system and the consequences for pain processing and susceptibility for development of chronic pain in later life. The discovery of microglia is accredited to Pío del Río-Hortega, who recognized this 'third element' of CNS cells as being morphologically distinct from neurons and astrocytes. For decades after this finding, microglia were altogether ignored or relegated as simply being support cells. Emerging from virtual obscurity, microglia have now gained notoriety as immune cells that assume a leading role in the development, maintenance and protection of a healthy CNS. Pioneering studies have recently shed light on the origins of microglia, their role in the developing nervous system and the complex roles they play beyond the immune response. These studies reveal that altered microglial function can have a profoundly negative impact on the developing brain and may be a determinant in a range of neurodevelopmental disorders and neurodegenerative diseases. The realization that aberrant microglial function also critically underlies chronic pain, a debilitating disorder that afflicts over 1.5billion people worldwide, was a major conceptual leap forward in the pain field. Adding to this advance is emerging evidence that early life noxious experiences can have a long-lasting impact on central pain processing and adult pain sensitivity. With microglia now coming of age, in this review we examine the association between adverse early life events, such as stress, injury or inflammation, and the influence of sex differences, on the role of microglia in pain physiology in adulthood.

Psychological stress in early life as a predisposing factor for the development of chronic pain: Clinical and preclinical evidence and neurobiological mechanisms.

A wealth of research over the past 2 decades has expanded our understanding of the impact of early-life adversity on physiological function and, consequently, health and wellbeing in later life. Early-life adversity increases the risk of developing a number of disorders, such as chronic pain, fibromyalgia, and irritable bowel syndrome. Although much of the research has examined the impact of physical maltreatment, an increasing number of studies have been published over the past few years examining the effect of childhood psychological stress and trauma on the development of various types of chronic pain conditions. We review the clinical and preclinical data examining the link among early-life psychological stress, altered nociceptive behavior, and chronic pain in later life. Evidence supporting a role for certain key neurobiological substrates, including the hypothalamic-pituitary-adrenal axis; monoaminergic, opioidergic, endocannabinoid and immune systems; and epigenetic mechanisms in the association between early-life psychological stress and chronic pain, is provided. Greater understanding of the impact of early-life stress may inform the development of personalized treatments for chronic pain in later life and strategies to prevent its onset in susceptible individuals. © 2016 Wiley Periodicals, Inc.

Living Well With Chronic Pain in Later Life: The Role and Meaning of Activity and Involvement

Objective: To examine how older people can best be helped to live well with musculoskeletal pain. Methods: A mixed-methods study integrating quantitative analysis of a longitudinal cohort survey with 60 semi-structured interviews. Results: Comparison of “expected” to “reported” interference suggested that social activity, physical activity, and “involvement” were important for participants who reported minimal interference from their pain. Discussion: For many older people with chronic pain, activity and involvement may not simply be outcomes of living with minimal interference from pain, but factors that contribute to this outcome and give meaning to their lives.

The effect of tail-docking neonate piglets on ATF-3 and NR2B immunoreactivity in coccygeal dorsal root ganglia and spinal cord dorsal horn neurons: Preliminary data

Abstract Background/aims Tail docking neonatal piglets remains a controversial animal welfare issue. Although banned in the UK, it is widely practiced in many countries as a safeguard against tail biting among pigs reared in intensive systems. Concerns exist whether tail docking can induce chronic pain in later life. This preliminary study examined the effects of partial tail amputation on activating transcription factor 3 (ATF3), a marker of peripheral nerve injury and regeneration and NMDA-glutamate receptor NR2B subunit which participates in the mediation of chronic pain. Methods Procedures were performed according to the ethical guidelines for the study of experimental pain in animals. Six piglets (2–3 days old) were tail-docked (a portion of the tail amputated with sterile surgical cutters), six piglets (2–3 days old) were sham-docked. Three animals from each treatment were euthanised 7 and 56 days post-amputation. Coccygeal dorsal root ganglia (DRG) and spinal cord were collected post-mortem for immunohistochemistry. Results ATF3 immunoreactivity (IR) was significantly increased (p <0.05) in the DRG neurons from tail-docked piglets 7 days after tail amputation, compared with sham-docked piglets. ATF3-IR was not different in sham and tail-docked piglets 56 days post amputation. NR2B-IR was significantly increased (p < 0.05) in dorsal horn neurons in tail-docked piglets compared with intact piglets 7 days after docking. There was no difference in NR2B-IR in neurons 56 days post amputation, compared with intact piglets. Conclusions Increased ATF3 and NR2B-IR 7 days after tail-docking suggests that injury to the peripheral nerves in the tail was sufficient to trigger neuronal regeneration and altered dorsal horn signaling respectively, however the effects of tail-docking on neuronal regeneration and nociceptive signaling were relatively short lasting. Tail-docking neonatal piglets does not cause sustained changes in ATF3, which might suggest ongoing nerve fibre damage and NR2B which might be implicated in chronic pain.

The effect of tail docking neonate piglets on ATF-3 and NR2B immunoreactivity in coccygeal dorsal root ganglia and spinal cord dorsal horn neurons: preliminary study

Background/aims: Tail docking neonatal piglets remains a controversial animal welfare issue. Although banned in the UK, it is widely practiced in many countries as a safeguard against tail biting among pigs reared in intensive systems. Concerns exist whether tail docking can induce chronic pain in later life. This preliminary study examined the effects of partial tail amputation on activating transcription factor 3 (ATF3), a marker of peripheral nerve injury and regeneration and NMDA-glutamate receptor NR2B subunit which participates in the mediation of chronic pain. Methods: Procedures were performed according to the ethical guidelines for the study of experimental pain in animals. Six piglets (2-3 days old) were tail-docked (a portion of the tail amputated with sterile surgical cutters), six piglets (2-3 days old) were sham-docked. Three animals from each treatment were euthanised 7 and 56 days post-amputation. Coccygeal dorsal root ganglia (DRG) and spinal cord were collected post-mortem for immunohistochemistry. Results: ATF3 immunoreactivity (IR) was significantly increased (p <0.05) in the DRG neurons from tail-docked piglets 7 days after tail amputation, compared with sham-docked piglets. ATF3-IR was not different in sham and tail-docked piglets 56 days post amputation. NR2B-IR was significantly increased (p < 0.05) in dorsal horn neurons in tail-docked piglets compared with intact piglets 7 days after docking. There was no difference in NR2B-IR in neurons 56 days post amputation, compared with intact piglets. Conclusions: Increased ATF3 and NR2B-IR 7 days after tail-docking suggests that injury to the peripheral nerves in the tail was sufficient to trigger neuronal regeneration and altered dorsal horn signaling respectively, however the effects of tail-docking on neuronal regeneration and nociceptive signaling were relatively short lasting. Tail-docking neonatal piglets does not cause sustained changes in ATF3, which might suggest ongoing nerve fibre damage and NR2B which might be implicated in chronic pain.

Chronic Pain in Later Life: A Review of Current Issues and Challenges

The effects of aging present a major medical challenge in the 21st century, which will cause fundamental changes in demography. By 2031, it is estimated that 22% of the UK population will be aged over 65 years, and there will be more people in this age group than aged under 25 years. As well as implications for infrastructure and productivity, this change will alter the prevalence and impact of many illnesses and pathologies. The research priorities of many of the major funding bodies reflect this challenge. The Medical Research Council in the UK, for example, leads the Lifelong Health and Wellbeing program on behalf of all the country’s research councils. This initiative aims to identify factors that affect or improve health in later life, to inform relevant policy and practice. The Wellcome Trust lists the investigation of development, aging and chronic disease as one of its five major research challenges, and the European Commission presents the health of the aging population as one of its three overarching issues of the Health Theme in its 7th Framework Program of research. Chronic pain is a major health condition associated with aging, whose management (pharmacological and nonpharmacological) is generally unsatisfactory. The International Association for the Study of Pain designated 2006/07 as its Global Year Against Pain in Older Adults. This article reviews the relevance of existing and potential research on the assessment and management of chronic pain in older adults.

Primary care providers' perspective on prescribing opioids to older adults with chronic non-cancer pain: A qualitative study

BackgroundThe use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults.MethodsSix focus groups were conducted with a total of 23 physicians and three nurse practitioners from two academically affiliated primary care practices and three community health centers located in New York City. Focus groups were audiotape recorded and transcribed. The data were analyzed using directed content analysis; NVivo software was used to assist in the quantification of identified themes.ResultsMost participants (96%) employed opioids as therapy for some of their older patients with chronic pain, although not as first-line therapy. Providers cited multiple barriers, including fear of causing harm, the subjectivity of pain, lack of education, problems converting between opioids, and stigma. New barriers included patient/family member reluctance to try an opioid and concerns about opioid abuse by family members/caregivers. Studies confirming treatment benefit, validated tools for assessing risk and/or dosing for comorbidities, improved conversion methods, patient education, and peer support could facilitate opioid prescribing. Participants voiced greater comfort using opioids in the setting of delivering palliative or hospice care versus care of patients with chronic pain, and expressed substantial frustration managing chronic pain.ConclusionsProviders perceive multiple barriers to prescribing opioids to older adults with chronic pain, and use these medications cautiously. Establishing the long-term safety and efficacy of these medications, generating improved prescribing methods, and implementing provider and patient educational interventions could help to improve the management of chronic pain in later life.

Chronic pain in later life: a selectively annotated bibliography

Introduction Assessment of Chronic Pain The Human Body and Chronic Pain Disease and Chronic Pain Perceptions of Chronic Pain Treatment of Chronic Pain Correlates and Consequences of Chronic Pain Appendix A: Older Adults and Cancer Pain Appendix B: International Citations Author Index Subject Index

Correlates and Consequences of Chronic Pain in Older Adults

Chronic pain is a frequent challenge to older adults’ coping skills. Despite the widespread occurrence of chronic geriatric pain, no comprehensive body of literature on this topic exists. Instead, research on chronic pain is scattered across disciplines and is perceived as inaccessible by scientists. We completed a comprehensive review and qualitative analysis of the geriatric chronic pain literature since 1990 and found 314 articles on this topic that reported North American research. Physical, social, and psychologic variables associated with chronic pain and the elderly were mentioned in just over half (53%) of the articles. However, both psychosocial causes and consequences of chronic pain were understudied. Only 16% of the articles had social variables (gender, race, and age) as their primary interest; 27% focused on psychologic or psychiatric issues, with half including depression as the variable of interest. An analysis of the articles’ content suggests that research on chronic pain in later life would be substantially improved if a more structured and comprehensive approach were used that combined the study of psychosocial issues with that of physical pain. Researchers and clinicians with a global understanding of chronic pain might help improve quality of life for older adults. (Geriatr Nurs 2000;21:270-3)

The Study of Chronic Pain in Later Life:

Chronic pain often accompanies the predominant nonfatal chronic conditions experienced by older women. Population estimates suggest that 25-50% of community-dwelling older adults suffer as a result of chronic pain problems. Despite the prevalence of chronic pain among older adults, very little attention has been given to the consequences associated with living with chronic pain in later life. Within the limited geriatric pain literature, virtually no attention has been directed towards chronic pain among older women.

The Physiology and Biomedical Aspects of Chronic Pain in Later Life

Pain is a complex phenomenon. In order to understand pain perception one must attempt to understand pain physiology and how certain physiologic and biomedical changes associated with aging may influence the elderly person's pain perception. Understanding the varied changes that occur with aging is very important in diagnosing and managing pain in the elderly population.