期刊
JOURNAL OF GERIATRIC PSYCHIATRY AND NEUROLOGY
卷 25, 期 4, 页码 240-255出版社
SAGE PUBLICATIONS INC
DOI: 10.1177/0891988712466457
关键词
dementia; lateral pain network; medial pain network; rostral pain network; pain behaviors; pain processing in people with dementia; neurobiology of pain in dementia
资金
- John A. Hartford Foundation & Atlantic Philanthropies
- Mayday Fund
- Vanderbilt Institute for Clinical and Translational Research - Vanderbilt CTSA grant from NCRR/NIH [UL1 RR024975]
Pain management in people with dementia is a critical problem. Recently, psychophysical and neuroimaging techniques have been used to extend our understanding of pain processing in the brain as well as to identify structural and functional changes in Alzheimer disease (AD). But interpreting the complex relationship between AD pathology, brain activation, and pain reports is challenging. This review proposes a conceptual framework for designing and interpreting psychophysical and neuroimaging studies of pain processing in people with AD. Previous human studies describe the lateral (sensory) and medial (affective) pain networks. Although the majority of the literature on pain supports the lateral and medial networks, some evidence supports an additional rostral pain network, which is believed to function in the production of pain behaviors. The sensory perception of pain as assessed through verbal report and behavioral display may be altered in AD. In addition, neural circuits mediating pain perception and behavioral expression may be hyperactive or underactive, depending on the brain region involved, stage of the disease, and type of pain (acute experimental stimuli or chronic medical conditions). People with worsening AD may therefore experience pain but be unable to indicate pain through verbal or behavioral reports, leaving them at great risk of experiencing untreated pain. Psychophysical (verbal or behavioral) and neurophysiological (brain activation) approaches can potentially address gaps in our knowledge of pain processing in AD by revealing the relationship between neural processes and verbal and behavioral outcomes in the presence of acute or chronic pain.
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