Is the Presence of Mild to Moderate Cognitive Impairment Associated With Self-Report of Non-cancer Pain? A Cross-Sectional Analysis of a Large Population-Based Study

Context: Research, guidelines, and experts in the field suggest that persons with cognitive impairment report pain less often and at a lower intensity than those without cognitive impairment. However, this presupposition is derived from research with important limitations, namely, inadequate power and lack of multivariate adjustment. Objectives: We conducted a cross-sectional analysis of the Canadian Study of Health and Aging to evaluate the relationship between cognitive status and pain self-report. Methods: Cognitive status was assessed using the Modified Mini-Mental State Examination. Pain was assessed using a 5-point verbal descriptor scale. For analysis, responses were dichotomized into "no pain" vs. "any pain" and "pain at a moderate or higher intensity" vs. "pain not at a moderate or higher intensity." Additional predictors included demographics, physical function, depression, and comorbidity. Results: Of 5,703 eligible participants, 306 (5.4%) did not meet inclusion criteria, leaving a total of 5,397, of whom 876 (16.2%) were cognitively impaired. In the unadjusted analysis, significantly more cognitively intact (n = 2,541; 56.2%) than cognitively impaired (n = 456; 52.1%; P = 0.03) participants reported noncancer pain. There was no significant difference in the proportion of cognitively intact (n = 1,623; 35.9%) and impaired (n = 329; 37.6%; P = 0.36) participants who reported pain to be at moderate or higher intensity. In multivariate analyses, cognitively impaired participants did not have lower odds of reporting any noncancer pain (odds ratio [OR] = 0.83 [0.68-1.01]; P = 0.07) or pain at a moderate or higher intensity (OR = 0.95 [0.78-1.16]; P = 0.62). Conclusion: Non-cancer pain was equally prevalent in people with and without cognitive impairment, which contrasts with the currently held opinion that cognitively impaired persons report noncancer pain less often and at a lower intensity.