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J Pain Symptom Manage. 2010 Apr;39(4):734-42. doi: 10.1016/j.jpainsymman.2009.09.016.

Is the presence of mild to moderate cognitive impairment associated with self-report of non-cancer pain? A cross-sectional analysis of a large population-based study.

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Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois, USA.



Research, guidelines, and experts in the field suggest that persons with cognitive impairment report pain less often and at a lower intensity than those without cognitive impairment. However, this presupposition is derived from research with important limitations, namely, inadequate power and lack of multivariate adjustment.


We conducted a cross-sectional analysis of the Canadian Study of Health and Aging to evaluate the relationship between cognitive status and pain self-report.


Cognitive status was assessed using the Modified Mini-Mental State Examination. Pain was assessed using a 5-point verbal descriptor scale. For analysis, responses were dichotomized into "no pain" vs. "any pain" and "pain at a moderate or higher intensity" vs. "pain not at a moderate or higher intensity." Additional predictors included demographics, physical function, depression, and comorbidity.


Of 5,703 eligible participants, 306 (5.4%) did not meet inclusion criteria, leaving a total of 5,397, of whom 876 (16.2%) were cognitively impaired. In the unadjusted analysis, significantly more cognitively intact (n=2,541; 56.2%) than cognitively impaired (n=456; 52.1%; P=0.03) participants reported noncancer pain. There was no significant difference in the proportion of cognitively intact (n=1,623; 35.9%) and impaired (n=329; 37.6%; P=0.36) participants who reported pain to be at moderate or higher intensity. In multivariate analyses, cognitively impaired participants did not have lower odds of reporting any noncancer pain (odds ratio [OR]=0.83 [0.68-1.01]; P=0.07) or pain at a moderate or higher intensity (OR=0.95 [0.78-1.16]; P=0.62).


Non-cancer pain was equally prevalent in people with and without cognitive impairment, which contrasts with the currently held opinion that cognitively impaired persons report noncancer pain less often and at a lower intensity.

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