Department of Neuroscience, University of Turin, Italy National Institute of Neuroscience, Turin, Italy Division of Neurology, S. Lazzaro Medical Center, Alba, Italy Department of Medical and Surgical Disciplines, University of Turin, Italy Centro Riabilitazione Ferrero S.r.l., Alba, Italy.
Pain. 2010 Dec;151(3):783-789. doi: 10.1016/j.pain.2010.09.013. Epub 2010 Oct 8.
Pain management in elderly people with cognitive impairment poses special challenges, due to difficulties in pain assessment and specific neurodegenerative changes along pain pathways. Most studies have concentrated on Alzheimer's disease (AD) patients, in whom some contrasting findings have been found. For example, while psychophysical data suggest a selective blunting of the affective dimension of pain, pain-related fMRI signal increases have also been described. Few data have been reported in patients with frontotemporal dementia (FTD). By electrical stimulation, we have measured pain threshold and pain tolerance in clinically diagnosed FTD patients with SPECT cerebral hypoperfusion. We performed our analysis on two separate and overlapping subgroups selected on the basis of (1) neuropsychological scores below cut-off values (2) a strictly localized frontal and/or temporal hypoperfusion. We observed increased pain threshold in the first group and increased pain threshold and pain tolerance in the second group. Our results suggest differences in pain processing changes in distinct types of dementia, while at the same time caution that pain perception assessment may depend on the criteria adopted for diagnosis.
老年人认知障碍的疼痛管理带来了特殊的挑战，因为在疼痛评估和特定的沿疼痛途径的神经退行性变化方面存在困难。大多数研究都集中在阿尔茨海默病（AD）患者身上，在这些患者中发现了一些相互矛盾的发现。例如，虽然心理物理学数据表明疼痛的情感维度选择性减弱，但也描述了与疼痛相关的 fMRI 信号增加。在额颞叶痴呆（FTD）患者中报告的数据很少。通过电刺激，我们在 SPECT 脑灌注不足的临床诊断为 FTD 患者中测量了疼痛阈值和疼痛耐受度。我们根据以下两个独立且重叠的亚组进行了分析：（1）神经心理学评分低于临界值；（2）严格的额颞叶局限性低灌注。我们观察到第一组的疼痛阈值增加，第二组的疼痛阈值和疼痛耐受度增加。我们的结果表明，不同类型的痴呆症的疼痛处理变化存在差异，同时也警告说，疼痛感知评估可能取决于用于诊断的标准。
