Persistent Non-pharmacological Pain Management and Brain-Predicted Age Differences in Middle-Aged and Older Adults With Chronic Knee Pain

Abstract

Chronic pain has been associated with changes in pain-related brain structure and function, including advanced brain aging. Non-pharmacological pain management is central to effective pain management. However, it is currently unknown how use of non-pharmacological pain management is associated with pain-related brain changes. The objective of the current study was to examine the association between brain-predicted age difference and use of non-pharmacological pain management (NPM) in a sample of middle-aged and older adults with and without chronic knee pain across two time points. One-hundred and 12 adults (mean age = 57.9 ± 8.2 years) completed sociodemographic measures, clinical pain measures, structural T1-weighted brain magnetic resonance imaging, and self-reported non-pharmacological pain management. Using a validated approach, we estimated a brain-predicted age difference (brain-PAD) biomarker, calculated as brain-predicted age minus chronological age, and the change in brain-PAD across 2 years. Repeated measures analysis of covariance was conducted to determine associations of non-pharmacological pain management and brain-PAD, adjusting for age, sex, study site, and clinical pain. There was a significant time^*pain/NPM interaction effect in brain-PAD (p < 0.05). Tests of simple main effects indicated that those persistently using NPM had a "younger" brain-PAD over time, suggesting a potential protective factor in persistent NPM use. Future studies are warranted to determine the influence of NPM in brain aging and pain-related neurological changes.

Keywords: brain age; chronic musculoskeletal pain; clinical pain; knee osteoarthritis; non-pharmacological.

Figure 1

Brain-PAD at baseline and 2-year follow-up across groups, controlling for age, sex, study site, and pain grade at both time points: Pain-free, those with chronic pain using non-pharmacological pain management (NPM), and chronic pain not using NPM. Error bars represent standard error.

Figure 2

(A) graded chronic pain scale (GCPS) pain intensity and (B) GCPS pain-related disability at baseline and 2-year follow-up between non-pharmacological pain management (NPM) groups, controlling for age, sex, and study site. Error bars represent standard error.