Stubbs, Brendon, Thompson, Trevor ORCID: 0000-0001-9880-782X, Solmi, Marco, Vancampfort, Davy, Sergi, Giuseppe, Luchini, Claudio and Veronese, Nicola (2016) Is pain sensitivity altered in people with Alzheimer's disease? A systematic review and meta-analysis of experimental pain research. Experimental Gerontology, 82. pp. 30-38. ISSN 0531-5565 (doi:https://doi.org/10.1016/j.exger.2016.05.016)

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Abstract

Background: Clinical studies suggest people with Alzheimer's disease (AD) have altered pain sensitivity. Experimental pain research is equivocal.

Objective: Conduct a meta-analysis to investigate if people with AD have altered pain sensitivity compared to healthy controls (HCs).

Methods: Three authors searched electronic databases from inception till November 2015 for experimental pain studies in AD vs. HCs. Outcome measures were pain threshold, tolerance, pain ratings, heart rate response to nox- ious stimuli and the Facial Action Coding System (FACS). Random effect meta-analysis calculating Hedges' g ± 95% confidence intervals (CI) was conducted.

Results: Thirteen studies were identified, including 256 people with AD (74.6 (±5.6) years, 59% females with a mean mini mental state examination (MMSE) score of 19.2) and 260 HCs. Meta-analysis demonstrated no signif- icant difference in pain threshold (g = 0.025, 95% CI −0.315-0.363, p = 0.88, n AD = 135, n HCs = 157), pain tolerance (g = −0.363, 95% CI −2.035-1.309, p = 0.67, n AD = 41, n HCs = 53) or pain intensity ratings (g = 0.03, p = 0.89, n AD = 138, n HCs = 135). Heart rate response to pain was less pronounced in AD but not significant (g = −0.746, p = 0.11). People with AD (n = 90) had significantly higher FACS scores versus HCs (n = 109) (g = 0.442, p = 0.03) indicating increased pain. Meta-regression demonstrated that an increasing percentage of AD female participants moderated pain threshold (p = 0.02) whilst MMSE scores did not (p = 0.19).

Conclusion: People with AD have a greater sensitivity to pain when validated observer ratings of facial expres- sions are used. Verbal response to painful stimuli, even under experimental conditions, may mean pain is not identified in people with AD. Clinically useful observer rated pain tools may be the most appropriate way to as- sess pain in AD.

Item Type:	Article
Additional Information:	© 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license.
Uncontrolled Keywords:	Alzheimer's disease; Dementia pain; Experimental pain; Meta-analysis; Systematic review
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Last Modified:	22 Feb 2018 10:05
URI:	http://gala.gre.ac.uk/id/eprint/15833

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