Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida; Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, Florida.
Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida.
J Pain. 2024 May;25(5):104423. doi: 10.1016/j.jpain.2023.11.006. Epub 2023 Nov 10.
Chronic pain is driven by factors across the biopsychosocial spectrum. Previously, we demonstrated that magnetic resonance images (MRI)-based brain-predicted age differences (brain-PAD: brain-predicted age minus chronological age) were significantly associated with pain severity in individuals with chronic knee pain. We also previously identified four distinct, replicable, multidimensional psychological profiles significantly associated with clinical pain. The brain aging-psychological characteristics interface in persons with chronic pain promises elucidating factors contributing to their poor health outcomes, yet this relationship is barely understood. That is why we examined the interplay between the psychological profiles in participants having chronic knee pain impacting function, brain-PAD, and clinical pain severity. Controlling for demographics and MRI scanner, we compared the brain-PAD among psychological profiles at baseline (n = 164) and over two years (n = 90). We also explored whether profile-related differences in pain severity were mediated by brain-PAD. Brain-PAD differed significantly between profiles (ANOVA's omnibus test, P = .039). Specifically, participants in the profile 3 group (high negative/low positive emotions) had an average brain-PAD ∼4 years higher than those in profile- (low somatic reactivity), with P = .047, Bonferroni-corrected, and than those in profile 2 (high coping), with P = .027, uncorrected. Repeated measures ANOVA revealed no significant change in profile-related brain-PAD differences over time, but there was a significant decrease in brain-PAD for profile 4 (high optimism/high positive affect), with P = .045. Moreover, profile-related differences in pain severity at baseline were partly explained by brain-PAD differences between profile 3 and 1, or 2; but brain-PAD did not significantly mediate the influence of variations in profiles on changes in pain severity over time. PERSPECTIVE: Accelerated brain aging could underlie the psychological-pain relationship, and psychological characteristics may predispose individuals with chronic knee pain to worse health outcomes via neuropsychological processes.
慢性疼痛是由生物心理社会因素共同作用导致的。此前，我们的研究表明，基于磁共振成像（MRI）的大脑预测年龄差异（brain-PAD：大脑预测年龄减去实际年龄）与慢性膝痛患者的疼痛严重程度显著相关。我们之前还发现了四个不同的、可复制的多维心理特征与临床疼痛显著相关。在慢性疼痛患者中，大脑衰老与心理特征的相互关系有望阐明导致其健康状况不佳的因素，但目前对此知之甚少。这就是为什么我们要研究慢性膝痛患者的心理特征与大脑预测年龄差异（brain-PAD）和临床疼痛严重程度之间的相互作用。在控制了人口统计学和 MRI 扫描仪的影响后，我们比较了基线时（n = 164）和两年后（n = 90）各心理特征的 brain-PAD。我们还探讨了疼痛严重程度与 brain-PAD 之间是否存在相关性。结果发现，各心理特征之间的 brain-PAD 存在显著差异（方差分析的整体检验，P =.039）。具体来说，与 profile-1（低躯体反应性）相比，profile-3（高负性情绪/低正性情绪）的参与者的平均 brain-PAD 高约 4 岁，P =.047，Bonferroni 校正；与 profile-2（高应对能力）相比，P =.027，未校正。重复测量方差分析显示，随着时间的推移，与 profile 相关的 brain-PAD 差异没有显著变化，但 profile-4（高乐观/高正性情绪）的 brain-PAD 显著下降，P =.045。此外，基线时疼痛严重程度与 profile 相关的差异部分由 profile-3 和 1 或 2 之间的 brain-PAD 差异解释；但 brain-PAD 并不能显著中介 profile 变化对疼痛严重程度随时间变化的影响。观点：加速大脑衰老可能是心理-疼痛关系的基础，而心理特征可能通过神经心理过程使慢性膝痛患者更容易出现健康状况不佳的结果。
