Cognitive and Affective Neuroscience and Clinical Psychology, Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain.
Department of Old Age Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.
Eur J Pain. 2021 Aug;25(7):1472-1481. doi: 10.1002/ejp.1760. Epub 2021 Mar 26.
Pain expectation and controllability can modulate pain processing. However, little is known about age-related effects on these cognitive factors involved in pain control. This study assessed age-related brain changes associated with pain expectation and controllability.
17 healthy older adults (9 men; 65.65 ± 4.34 years) and 18 healthy younger adults (8 men; 20.56 ± 5.56 years) participated in the study. Pain evoked potentials and pain ratings were recorded while participants received painful electrical stimuli under two different conditions of pain controllability over the intensity of the stimulation (self-controlled vs. computer controlled) and two conditions of pain expectations (high vs. low pain).
Although the intensity of the painful stimulation was kept constant, all participants showed reduced pain perception in the controllable and low pain expectancy conditions. However, older participants showed reduced amplitudes of pain evoked potentials in the time window between 150 and 500 ms after stimulus onset as compared to younger participants. Moreover, younger participants showed greater negative amplitudes from 80 to 150 ms after stimulus onset for uncontrollable versus controllable pain.
These results suggest that although cognitive pain modulation is preserved during ageing, neural processing of pain is reduced in older adults.
This research describes the impact of age on cognitive pain modulation evoked by the manipulation of pain controllability and pain expectations. Our findings constitute a first step in the understanding of the greater vulnerability of older individuals to chronic pain. Moreover, we show that older adults can benefit from cognitive pain control mechanisms to increase the efficacy of pain treatments.
疼痛预期和可控性可以调节疼痛处理。然而，对于这些涉及疼痛控制的认知因素的年龄相关影响知之甚少。本研究评估了与疼痛预期和可控性相关的年龄相关的大脑变化。
17 名健康的老年人（9 名男性；65.65±4.34 岁）和 18 名健康的年轻人（8 名男性；20.56±5.56 岁）参加了这项研究。当参与者在两种不同的可控性条件下（自我控制与计算机控制）和两种不同的疼痛预期条件（高预期与低预期）下接受疼痛强度可控的电刺激时，记录了疼痛诱发电位和疼痛评分。
尽管疼痛刺激的强度保持不变，但所有参与者在可控性和低疼痛预期条件下都表现出疼痛感知降低。然而，与年轻参与者相比，老年参与者在刺激后 150 至 500 毫秒的时间窗口内显示出疼痛诱发电位的振幅降低。此外，年轻参与者在刺激后 80 至 150 毫秒的时间窗口内显示出不可控疼痛与可控疼痛之间的负振幅更大。
这些结果表明，尽管认知性疼痛调节在衰老过程中得以保留，但老年人的疼痛神经处理能力降低。
本研究描述了年龄对疼痛可控性和疼痛预期操纵引起的认知性疼痛调节的影响。我们的发现构成了理解老年人对慢性疼痛更易感性的第一步。此外，我们表明，老年人可以从认知性疼痛控制机制中受益，以提高疼痛治疗的效果。
