摘要
目的 探讨疼痛与认知损害之间的关系,并评估疼痛管理对这一风险的影响。方法 利用中国健康与养老追踪调查数据库2011至2018年的数据,进行横断面和纵向动态分析。横断面分析采用多元线性回归与广义加性模型评估疼痛与认知的关系,并通过中介分析探讨间接路径。纵向动态分析采用潜在类别增长模型识别认知评分以及疼痛部位数量变化轨迹,并通过多因素logistic回归分析评估疼痛多维特征对认知损害的动态影响。结果 在4 957例45岁及以上的参与者中,27.7%报告存在基线疼痛。横断面分析显示,慢性疼痛与认知评分显著负相关(β=-0.62,P<0.001),其影响程度因疼痛特定部位及部位数量而异。中介分析表明,活动受限、抑郁及其交互作用分别可以解释疼痛与认知评分之间9%、27%和5%的关联。纵向动态分析显示,持续性疼痛(OR=2.35,P<0.001)和多部位疼痛(OR=2.28,P<0.001)均增加了认知下降风险。此外,多次镇痛治疗(尤其是≥3次)也增加了认知损害的风险(OR=1.89,P=0.022)。结论频繁疼痛通过抑郁和活动受限的中介作用导致认知损害。疼痛管理可能无法有效降低这一风险,而过度使用镇痛药物可能对认知功能产生不利影响。
Objective To explore the relationship between pain and cognitive decline,and evaluate the impact of pain management on this risk.Methods Using data from the 2011—2018 China Health and Retirement Longitudinal Study(CHARLS),we conducted cross-sectional and longitudinal analysis.Multivariate regression and generalized additive models assessed pain-cognition associations,while mediation analysis examined indirect pathways.Latent class growth models(LCGM)captured trajectories of cognitive scores and number of pain sites changes,while multivariable logistic regression evaluated the dynamic effects of pain′s multidimensional characteristics on cognitive decline.Results Among 4,957 participants aged≥45,27.7%reported baseline pain.Chronic pain was cross-sectionally linked to lower cognitive scores(β=-0.62,P<0.001),with effects varying by pain sites and number of sites.Mediation analysis attributed 9%,27%and 5%of the association to mobility limitations,depression,and their interaction.Longitudinally,persistent pain(OR=2.35,P<0.001)and a multi-sites growth trajectory(OR=2.28,P<0.001)increased the risk of cognitive decline.Additionally,the risk of cognitive decline also rose with more analgesic sessions,especially≥3(OR=1.89,P=0.022).Conclusions Frequent pain can lead to cognitive decline through the mediating effects of depression and mobility limitations.Pain management may not reduce this risk,and excessive analgesics use could be harmful.
作者
张舒
朱顺
倪敬年
魏明清
李婷
李傅尧
肖伟
王团结
代玲玲
时晶
田金洲
Zhang Shu;Zhu Shun;Ni Jingnian;Wei Mingqing;Li Ting;Li Fuyao;Xiao Wei;Wang Tuanjie;Dai Lingling;Shi Jing;Tian Jinzhou(the Third Department of Brain Disorders,Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing 100700,China;Graduate School,Beijing University of Chinese Medicine,Beijing100029,China;State Key Laboratory on Technologies for Chinese Medicine Pharmaceutical Process Control and Intelligent Manufacture,Lianyungang 222001,Jiangsu,China)
出处
《中国医学前沿杂志(电子版)》
北大核心
2025年第5期109-117,共9页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
基金
北京中医药大学解码中医项目(BZY-JMZY-2022-002)
江苏省院士工作站(BM2023118)
中医学与中药学科创新引智基地(2024-JYB-KYPT-07)
新教师启动基金项目(2024-BUCMXJKY-054)。
作者简介
通信作者:时晶,E-mail:sshijing87@163.com。
